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Root KT, Hones KM, Hao KA, Brolin TJ, Wright JO, King JJ, Wright TW, Schoch BS. A Systematic Review of Patient Selection Criteria for Outpatient Total Shoulder Arthroplasty. Orthop Clin North Am 2024; 55:363-381. [PMID: 38782508 DOI: 10.1016/j.ocl.2023.12.002] [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: 05/25/2024]
Abstract
The utilization of total shoulder arthroplasty (TSA) is increasing, driving associated annual health care costs higher. Opting for outpatient over inpatient TSA may provide a solution by reducing costs. However, there is no single set of accepted patient selection criteria for outpatient TSA. Here, the authors identify and systematically review 14 articles to propose evidence-based criteria that merit postoperative admission. Together, the studies suggest that patients with limited ability to abmluate independently or a history of congestive heart failure may benefit from postoperative at least one night of hospital based monitoring and treatment.
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Affiliation(s)
- Kevin T Root
- College of Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL 32610, USA
| | - Keegan M Hones
- Department of Orthopaedics and Sports Medicine, University of Florida, 3450 Hull Road # 3341, Gainesville, FL 32607, USA
| | - Kevin A Hao
- College of Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL 32610, USA
| | - Tyler J Brolin
- Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, 1211 Union Avenue # 500, Memphis, TN 38104, USA
| | - Jonathan O Wright
- Department of Orthopaedics and Sports Medicine, University of Florida, 3450 Hull Road # 3341, Gainesville, FL 32607, USA
| | - Joseph J King
- Department of Orthopaedics and Sports Medicine, University of Florida, 3450 Hull Road # 3341, Gainesville, FL 32607, USA
| | - Thomas W Wright
- Department of Orthopaedics and Sports Medicine, University of Florida, 3450 Hull Road # 3341, Gainesville, FL 32607, USA
| | - Bradley S Schoch
- Department of Orthopedic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
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Grovu R, Quan T, Wei C, Das A, Nguyen A, Tabaie S, Zimmer ZR. Worsening of anemia increases the risks of complications and prolonged length of stay following revision total shoulder arthroplasty. Shoulder Elbow 2024; 16:285-293. [PMID: 38818105 PMCID: PMC11135193 DOI: 10.1177/17585732231172162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/08/2023] [Accepted: 04/09/2023] [Indexed: 06/01/2024]
Abstract
Background There are no studies currently in the literature that assesses complications following revision total shoulder arthroplasty (TSA) in patients with varying severity of anemia. The purpose of this study was to determine the impact of preoperative anemia severity on postoperative complications following revision TSA. Methods Patients undergoing revision TSA from 2013 to 2019 were queried in a national database. Based on previous studies' definitions of anemia, three subgroups were stratified: patients without anemia (hematocrit >36% for women, hematocrit >39% for men), patients with mild anemia (hematocrit 33% to 36% for women, hematocrit 33% to 39% for men) and patients with moderate to severe anemia (hematocrit <33% for both women and men). In this analysis, patient demographics, comorbidities, and postoperative complications were compared between the three groups. Results Of 1559 total patients undergoing revision TSA, 1178 patients (75.6%) did not have anemia, 255 (16.3%) had mild anemia, and 126 (8.1%) had moderate/severe anemia. Following adjustment on multivariate analysis, patients with mild anemia were more likely to have postoperative transfusion and extended length of stay compared to non-anemic patients. Patients with moderate/severe anemia were at increased risk of postoperative transfusion, sepsis, extended length of stay, and reoperation compared to non-anemic patients. Discussion From mild anemia to moderate/severe anemia, there was a stepwise increase in the risk of postoperative complications. Our study showed that there is clinical value in the preoperative correction of anemia for these patients as it relates to complications and hospital stay. Level of Evidence III.
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Affiliation(s)
- Radu Grovu
- Staten Island University Hospital, Staten Island, NY, USA
| | - Theodore Quan
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Chapman Wei
- Staten Island University Hospital, Staten Island, NY, USA
| | - Avilash Das
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Sean Tabaie
- Department of Orthopaedic Surgery, Children's National Health System, Washington, DC, USA
| | - Zachary R Zimmer
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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3
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Okpara S, Lee T, Pathare N, Ghali A, Momtaz D, Ihekweazu U. Cardiovascular Disease in Total Knee Arthroplasty: An Analysis of Hospital Outcomes, Complications, and Mortality. Clin Orthop Surg 2024; 16:265-274. [PMID: 38562631 PMCID: PMC10973625 DOI: 10.4055/cios23224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/16/2023] [Accepted: 09/16/2023] [Indexed: 04/04/2024] Open
Abstract
Background Cardiovascular comorbidities have been identified as a significant risk factor for adverse outcomes following surgery. The purpose of this study was to investigate its prevalence and impact on postoperative outcomes, hospital metrics, and mortality in patients undergoing total knee arthroplasty (TKA). Our hypothesis was that patients with cardiovascular comorbidities would have worse outcomes, greater postoperative complication rates, and increased mortality compared to patients without cardiovascular disease. Methods In this retrospective study, data from the National Inpatient Sample database from 2011 to 2020 were queried for patients who underwent TKA with preexisting cardiac comorbidities, including congestive heart failure (CHF), coronary artery disease (CAD), valvular dysfunction, and arrhythmia. Multivariate logistic regression analyses compared hospital metrics (length of stay, costs, and adverse discharge disposition), postoperative complications, and mortality rates while adjusting for demographic and clinical variables. All statistical analyses were performed using R studio 4.2.2 and Stata MP 17 and 18 with Python package. Results A total of 385,585 patients were identified. Those with preexisting CHF, CAD, valvular dysfunction, or arrhythmias were found to be older and at higher risk of adverse outcomes, including prolonged length of stay, increased hospital charges, and increased mortality (p < 0.001). Additionally, all preexisting cardiac diagnoses led to an increased risk of postoperative myocardial infarction, acute kidney injury (AKI), and need for transfusion (p < 0.001). The presence of valvular dysfunction, arrhythmia, or CHF was associated with an increased risk of thromboembolic events (p < 0.001). The presence of CAD and valvular dysfunction was associated with an increased risk of urologic infection (p < 0.001). Conclusions This study demonstrated that CHF, CAD, valvular dysfunction, and arrhythmia are prevalent among TKA patients and associated with worse hospital metrics, higher risk of perioperative complications, and increased mortality. As our use of TKA rises, a lower threshold for preoperative cardiology referral in older individuals and early preoperative counseling/intervention in those with known cardiac disease may be necessary to reduce adverse outcomes.
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Affiliation(s)
- Shawn Okpara
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Tiffany Lee
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Nihar Pathare
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Abdullah Ghali
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - David Momtaz
- Department of Orthopedics, UT Health Science Center at San Antonio, San Antonio, TX, USA
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4
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de Geofroy B, Micicoi G, Olmos M, Boileau P, Bronsard N, Gonzalez JF, Gauci MO. Early morbidity and mortality after one-stage bilateral shoulder arthroplasty. INTERNATIONAL ORTHOPAEDICS 2024; 48:505-511. [PMID: 37853140 DOI: 10.1007/s00264-023-06003-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE One-stage bilateral shoulder arthroplasty has the advantage of requiring a single hospital stay and a single anaesthesia. The topic has been little reported, unlike one stage bilateral hip and knee arthroplasty, which have demonstrated their interest. The aim of the present study was to determine peri- and early post-operative morbidity and mortality after this procedure. The study hypothesis was that peri- and early post-operative morbidity and mortality in one stage bilateral shoulder arthroplasty is low in selected patients and that satisfaction is high. METHODS A single-centre retrospective study assessed peri- and early post-operative morbidity and mortality in one stage bilateral shoulder arthroplasty. Twenty-one patients, aged < 80 years, with ASA score ≤ 3, were consecutively operated on between 1999 and 2020. Indications comprised primary osteoarthritis, aseptic osteonecrosis, inflammatory arthritis, massive rotator cuff tear, and dislocation fracture, involving both shoulders. RESULTS There were no early deaths. The complication rate was 10% (4/21 cases). No prosthesis dislocation or sepsis was reported. Mean blood loss was 145 ± 40 cc, mean surgery time 164 ± 63 min, and mean hospital stay five ± four days. Only one patient required postoperative transfusion. Functional results at six months showed significantly improved range of motion and good patient satisfaction. CONCLUSIONS One-stage bilateral shoulder arthroplasty was feasible in selected patients. Mortality was zero, and morbidity was low. Surgery time was reasonable and required no repositioning. Postoperative home help is indispensable for patient satisfaction during rehabilitation.
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Affiliation(s)
- Bernard de Geofroy
- Department of Orthopedic Surgery and Traumatology, Military Teaching Hospital, 34 Boulevard Laveran, 13384, Marseille, France
| | - Grégoire Micicoi
- Department of Orthopaedic Surgery and Sport Surgery, University Institute of Locomotion and Sport, University Hospital of Nice, 30 Av Voie Romaine, 06000 Cedex 1, Nice, CS, France
| | - Manuel Olmos
- Department of Orthopaedic Surgery and Sport Surgery, University Institute of Locomotion and Sport, University Hospital of Nice, 30 Av Voie Romaine, 06000 Cedex 1, Nice, CS, France
| | - Pascal Boileau
- Institut de Chirurgie Réparatrice, Groupe Kantys, Locomoteur & Sport, Clinique St Antoine7 Av Durante, 06000, Nice, France
| | - Nicolas Bronsard
- Department of Orthopedic Surgery and Traumatology, Military Teaching Hospital, 34 Boulevard Laveran, 13384, Marseille, France
| | - Jean-François Gonzalez
- Department of Orthopedic Surgery and Traumatology, Military Teaching Hospital, 34 Boulevard Laveran, 13384, Marseille, France
| | - Marc Olivier Gauci
- Department of Orthopedic Surgery and Traumatology, Military Teaching Hospital, 34 Boulevard Laveran, 13384, Marseille, France.
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Posner AD, Kuna MC, Carroll JD, Perloff EM, Anderson MJ, Hutchinson ID, Zimmerman JP. Anatomic total shoulder arthroplasty with a nonspherical humeral head and inlay glenoid: 90-day complication profile in the inpatient versus outpatient setting. Clin Shoulder Elb 2023; 26:380-389. [PMID: 37957884 DOI: 10.5397/cise.2023.00479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 08/19/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) with a nonspherical humeral head component and inlay glenoid is a successful bone-preserving treatment for glenohumeral arthritis. This study aimed to describe the 90-day complication profile of TSA with this prosthesis and compare major and minor complication and readmission rates between inpatient- and outpatient-procedure patients. METHODS A retrospective review was performed of a consecutive cohort of patients undergoing TSA with a nonspherical humeral head and inlay glenoid in the inpatient and outpatient settings by a single surgeon between 2017 and 2022. Age, sex, body mass index, American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), and 90-day complication and readmission rates were compared between inpatient and outpatient groups. RESULTS One hundred eighteen TSAs in 111 patients were identified. Mean age was 64.9 years (range, 39-90) and 65% of patients were male. Ninety-four (80%) and 24 (20%) patients underwent outpatient and inpatient procedures, respectively. Four complications (3.4%) were recorded: axillary nerve stretch injury, isolated ipsilateral arm deep venous thrombosis (DVT), ipsilateral arm DVT with pulmonary embolism requiring readmission, and gastrointestinal bleed requiring readmission. There were no reoperations or other complications. Outpatients were younger with lower ASA and CCI scores than inpatients; however, there was no difference in complications (1/24 vs. 3/94, P=1.00) or readmissions (1/24 vs. 1/94, P=0.37) between these two groups. CONCLUSIONS TSA with a nonspherical humeral head and inlay glenoid can be performed safely in both inpatient and outpatient settings. Rates of early complications and readmissions were low with no difference according to surgical setting. Level of evidence: IV.
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Affiliation(s)
- Andrew D Posner
- Department of Orthopedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Michael C Kuna
- Department of Orthopedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Jeremy D Carroll
- Department of Orthopedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Eric M Perloff
- Department of Orthopedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Matthew J Anderson
- Department of Orthopedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Ian D Hutchinson
- Department of Orthopedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Joseph P Zimmerman
- Department of Orthopedic Surgery, Albany Medical Center, Albany, NY, USA
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Agarwal AR, Wang KY, Xu AL, Ramamurti P, Zhao A, Best MJ, Srikumaran U. Outpatient Versus Inpatient Total Shoulder Arthroplasty: A Matched Cohort Analysis of Postoperative Complications, Surgical Outcomes, and Reimbursements. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202311000-00010. [PMID: 37973033 PMCID: PMC10656088 DOI: 10.5435/jaaosglobal-d-23-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 07/11/2023] [Accepted: 08/21/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION There has been a trend toward performing arthroplasty in the ambulatory setting. The primary purpose of this study was to compare outpatient and inpatient total shoulder arthroplasties (TSAs) for postoperative medical complications, healthcare utilization outcomes, and surgical outcomes. METHODS Patients who underwent outpatient TSA or inpatient TSA with a minimum 5-year follow-up were identified in the PearlDiver database. These cohorts were propensity-matched based on age, sex, Charlson Comorbidity Index, smoking status, and obesity (body mass index > 30). All outcomes were analyzed using chi square and Student t-tests where appropriate. RESULTS Outpatient TSA patients had markedly lower rates of various 90-day medical complications. Outpatient TSA patients had lower risk of aseptic loosening at 2 years postoperation and lower risk of periprosthetic joint infection at 5 years postoperation relative to inpatient TSA patients. Outpatient TSA reimbursements were markedly lower than inpatient TSA reimbursements at the 30-day, 90-day, and 1-year postoperative intervals. CONCLUSION This study found patients undergoing outpatient TSA to be at lowers odds for both postoperative medical and surgical complications compared with those undergoing inpatient TSA. Despite increased risk of postoperative healthcare utilization for readmissions and emergency department visits, outpatient TSA was markedly less expensive at every postoperative time point assessed.
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Affiliation(s)
- Amil R. Agarwal
- From the Johns Hopkins Department of Orthopaedic Surgery, Columbia, MD (Mr. Agarwal, Dr. Xu, Dr. Best, and Dr. Srikumaran); the Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC (Mr. Agarwal and Ms. Zhao); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wang); and the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Dr. Ramamurti)
| | - Kevin Y. Wang
- From the Johns Hopkins Department of Orthopaedic Surgery, Columbia, MD (Mr. Agarwal, Dr. Xu, Dr. Best, and Dr. Srikumaran); the Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC (Mr. Agarwal and Ms. Zhao); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wang); and the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Dr. Ramamurti)
| | - Amy L. Xu
- From the Johns Hopkins Department of Orthopaedic Surgery, Columbia, MD (Mr. Agarwal, Dr. Xu, Dr. Best, and Dr. Srikumaran); the Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC (Mr. Agarwal and Ms. Zhao); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wang); and the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Dr. Ramamurti)
| | - Pradip Ramamurti
- From the Johns Hopkins Department of Orthopaedic Surgery, Columbia, MD (Mr. Agarwal, Dr. Xu, Dr. Best, and Dr. Srikumaran); the Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC (Mr. Agarwal and Ms. Zhao); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wang); and the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Dr. Ramamurti)
| | - Amy Zhao
- From the Johns Hopkins Department of Orthopaedic Surgery, Columbia, MD (Mr. Agarwal, Dr. Xu, Dr. Best, and Dr. Srikumaran); the Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC (Mr. Agarwal and Ms. Zhao); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wang); and the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Dr. Ramamurti)
| | - Matthew J. Best
- From the Johns Hopkins Department of Orthopaedic Surgery, Columbia, MD (Mr. Agarwal, Dr. Xu, Dr. Best, and Dr. Srikumaran); the Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC (Mr. Agarwal and Ms. Zhao); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wang); and the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Dr. Ramamurti)
| | - Uma Srikumaran
- From the Johns Hopkins Department of Orthopaedic Surgery, Columbia, MD (Mr. Agarwal, Dr. Xu, Dr. Best, and Dr. Srikumaran); the Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC (Mr. Agarwal and Ms. Zhao); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wang); and the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Dr. Ramamurti)
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Karimi A, Jalalpour P, Reddy RP, Sabzevari S, Keeling LE, Lin A. Diagnostic arthroscopy for periprosthetic shoulder arthroplasty infections: a systematic review and meta-analysis. JSES Int 2023; 7:835-841. [PMID: 37719814 PMCID: PMC10499863 DOI: 10.1016/j.jseint.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background Periprosthetic joint infection of the shoulder (PJI) is a devastating complication with a reported incidence of 1%-15.4% and is often difficult to diagnose with current diagnostic tools including serologic tests and arthrocentesis. This systematic review evaluates the reliability and validity of arthroscopic biopsy in the current literature for the diagnosis of shoulder PJI. Methods MEDLINE, Scopus, Web of Sciences, Google Scholar, and Cochrane databases were queried electronically from inception to June 2022 for publications reporting diagnostic accuracy of shoulder arthroscopic biopsy for detecting infection after anatomic total shoulder arthroplasty, shoulder hemiarthroplasty, or reverse total shoulder arthroplasty. This systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results After exclusion, our meta-analysis consisted of 7 articles with a total of 112 patients. The estimated pooled sensitivity and specificity of arthroscopic biopsy for confirmation of shoulder periprosthetic infection were 0.87 (95% confidence interval [CI]: 0.73-0.95) and 0.79 (95% CI: 0.67-0.88), respectively. The pooled positive likelihood ratio and negative likelihood ratio were 4.15 (95% CI: 2.57, 6.70) and 0.17 (95% CI: 0.08, 0.36), respectively. The aggregate positive predictive value was 73.58% (95% CI: 63.29%-81.82%), and aggregate negative predictive value was 89.83% (95% CI: 80.59%-94.95%). The diagnostic odds ratio of arthroscopic biopsy was 19.92 (95% CI: 4.96-79.99). Conclusion Arthroscopic biopsy in patients suspected of shoulder PJI has good diagnostic accuracy, with high sensitivity and specificity. Given the various biopsy protocols (such as devices, numbers, locations, etc.), further prospective studies are necessary to define the future role of arthroscopic biopsy in diagnosis and treatment.
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Affiliation(s)
- Amin Karimi
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
- Research Development Unit, Department of Orthopedic Surgery, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pooyan Jalalpour
- Research Development Unit, Department of Orthopedic Surgery, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rajiv P Reddy
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Soheil Sabzevari
- Memorial Sloan Kettering Cancer Center, Weill Cornell University, New York City, NY, USA
| | - Laura E Keeling
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Albert Lin
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
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Salar R, Gümüş K, Bahçeci T, Erbin A. Comparative analysis of re-entry malecot and nelaton catheters after standard percutaneous nephrolithotomy in adult patients: a cross-sectional study. Urolithiasis 2023; 51:109. [PMID: 37615770 DOI: 10.1007/s00240-023-01475-x] [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: 01/31/2023] [Accepted: 07/31/2023] [Indexed: 08/25/2023]
Abstract
Drainage catheters are used almost routinely to provide urinary drainage, prevent extravasation of urine, and create tamponade against bleeding after percutaneous nephrolithotomy (PNL). In the literature, there is no standardized approach to determining which type of catheter is superior. In this context, we aimed to comparatively analyze two different types of catheters (re-entry malecot catheter and nelaton catheter) in terms of success and complications, which we use for drainage after a PNL operation and which have very different costs. Patients who underwent PNL for kidney stones between January 2018 and October 2022 were included in the study. The data of a total of 148 patients who had a 16-F reentry malecot nephrostomy catheter or a 16-F nelaton catheter were analyzed. In addition to the demographic characteristics of the patients, stone characteristics, operative data, hospitalization time, analgesia requirement, hemoglobin exchange, amount of blood transfusion, and postoperative data (success and complications) were comparatively evaluated. The current unit price for a reentry malecot and a nelaton catheter is 4.7 United States dollars (USD) and 0.11 USD, respectively. There were a total of 148 patients in the study, 63 of whom were nelaton catheters and 85 were reentry malecots, and the mean age was 39.95 ± 13.28 years. There was no statistically significant difference between preoperative stone sizes and residual stone rates according to the groups. In addition, there was no statistically significant difference between the groups in terms of access site and stone localization. There was no significant difference between the groups in terms of complication rates according to the Clavien-Dindo classification, Hb levels, blood transfusion rates, operation times, or hospitalization times. In conclusion, if a second procedure is planned, a reentry malecot catheter may be preferred. Apart from this situation, nelaton catheters should be preferred because they are similar to reentry catheters in terms of effectiveness, and side effects and are more economical than reentry catheters in terms of cost.
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Affiliation(s)
- Remzi Salar
- Department of Urology, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey.
| | - Kemal Gümüş
- Department of Urology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Tuncer Bahçeci
- Department of Urology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Akif Erbin
- Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey
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9
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Elgalli M, Hind J, Lahart I, Sidhu GAS, Athar S, Ashwood N. Outcomes of day case shoulder replacement surgery in a stand-alone day care unit in the United Kingdom. Shoulder Elbow 2023; 15:300-310. [PMID: 37325392 PMCID: PMC10268143 DOI: 10.1177/17585732211070822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/02/2021] [Accepted: 12/13/2021] [Indexed: 09/20/2023]
Abstract
Background This review aims to compare the outcomes for day case shoulder replacement with in-patient shoulder replacement surgery in a district general hospital. Methods Seventy-three patients had 82 shoulder arthroplasty procedures. Forty-six procedures were undertaken in a dedicated stand-alone day-case unit and 36 were undertaken as in-patient cases. Patient were followed up at 6 weeks, 6 months and annually. Results There was no significant difference between the outcomes of shoulder arthroplasty procedures performed in the day case or in-patient settings making this a safe option for surgical care in a unit with an appropriate care pathway. Six complications in total were observed, three in each group. Operation time was statistically shorter for day cases by 25.1 min (95% CI - 36.5 to -13.7; d = -0.95, 95% CI -1.42 to 0.48). Estimated marginal means (EMM) revealed lower post-surgery oxford pain scores in day cases (EMM = 3.25, 95% CI 2.35, 4.16) compared with inpatients (EMM = 4.65, 95% CI 3.64 to 5.67). Constant shoulder scores were higher in day cases versus inpatients. Conclusion Day case shoulder replacement is safe with comparable outcomes to routine inpatient care for patients up to ASA 3 classification with high satisfaction and excellent functional outcomes.
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Affiliation(s)
- Mosab Elgalli
- University Hospital Derby and Burton, Belvedere Rd, Burton-on-Trent, UK
| | - Jamie Hind
- University Hospital Derby and Burton, Belvedere Rd, Burton-on-Trent, UK
| | - Ian Lahart
- University of Wolverhampton, Gorway Road, Walsall, UK
| | | | - Sajjad Athar
- University Hospital Derby and Burton, Belvedere Rd, Burton-on-Trent, UK
| | - Neil Ashwood
- University Hospital Derby and Burton, Belvedere Rd, Burton-on-Trent, UK
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10
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Allen J, Abdelmonem M, Fieraru G, Guyver P. Introducing A Day-Case Shoulder Arthroplasty Pathway In The UK - How We Did It. Shoulder Elbow 2023; 15:311-320. [PMID: 37325384 PMCID: PMC10268136 DOI: 10.1177/17585732221079582] [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: 11/28/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 09/20/2023]
Abstract
Background As the demand for elective orthopaedics grows, day-case arthroplasty is gaining popularity. The aim of this study was to create a safe and reproducible pathway for day-case shoulder arthroplasty (DCSA) based upon a literature review and discussion with the local multidisciplinary team (MDT). Methods A literature review was performed using OVID MEDLINE and Embase databases reporting 90-day complication and admission rates following DCSA. Minimum follow-up was 30 days. Day-case was defined as discharge on the same day of surgery. Results The literature review revealed a mean 90-day complication rate of 7.7% [range, 0-15.9%] and mean 90-day readmission rate of 2.5% [range 0-9.3%]. A pilot protocol was devised based upon the literature review and consisted of 5 phases: (1) pre-operative assessment, (2) intra-operative phase, (3) post-operative phase, (4) follow-up, and (5) readmission protocol. This was presented, discussed, amended, and ultimately ratified by the local MDT. In May 2021 the unit successfully completed its first day-case shoulder arthroplasty. Discussion This study proposes a safe and reproducible pathway for DCSA. Patient selection, well-defined protocols and communication within the MDT are important factors to achieve this. Further studies with extended follow-up will be needed to gauge long-term success within our unit.
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Affiliation(s)
- James Allen
- Derriford Hospital, University Hospitals Plymouth NHS Trust, Huddersfield, UK
- Huddersfield Royal Infirmary, Huddersfield, UK
| | - Mohamed Abdelmonem
- Derriford Hospital, University Hospitals Plymouth NHS Trust, Huddersfield, UK
| | - Gabriel Fieraru
- Derriford Hospital, University Hospitals Plymouth NHS Trust, Huddersfield, UK
| | - Paul Guyver
- Derriford Hospital, University Hospitals Plymouth NHS Trust, Huddersfield, UK
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11
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Sudah S, Menendez M, Jawa A, Levy J, Denard P. Wide Geographic Variation in Resource Utilization after Shoulder Arthroplasty. Orthop Rev (Pavia) 2023; 15:38653. [PMID: 36843859 PMCID: PMC9946799 DOI: 10.52965/001c.38653] [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] [Indexed: 02/28/2023] Open
Abstract
Background There is growing interest in optimizing cost and resource utilization after shoulder arthroplasty, but little data to guide improvement efforts. Objective The purpose of this study was to evaluate geographic variation in length of stay and home discharge disposition after shoulder arthroplasty across the United States. Methods The Centers for Medicare and Medicaid Services database was used to identify Medicare discharges following shoulder arthroplasties performed from April 2019 through March 2020. National, regional (Northeast, Midwest, South, West), and state-level variation in length of stay and home discharge disposition rates were examined. The degree of variation was assessed using the coefficient of variation, with a value greater than 0.15 being considered as "substantial" variation. Geographic maps were created for visual representation of the data. Results There was substantial state-level variation in home discharge disposition rates (64% in Connecticut to 96% in West Virginia) and length of stay (1.01 days in Delaware to 1.86 days in Kansas). There was wide regional variation in length of stay (1.35 days in the West to 1.50 days in the Northeast) and home discharge disposition rates (73% in the Northeast to 85% in the West). Conclusions There is wide variation in resource utilization after shoulder arthroplasty across the United States. Certain patterns emerge from our data; for instance, the Northeast has the longest hospital stays with the lowest home discharge rates. This study provides important information for the implementation of targeted strategies to effectively reduce geographic variation in healthcare resource utilization.
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Affiliation(s)
| | | | - Andrew Jawa
- Orthopedic SurgeryNew England Baptist Hospital
| | | | - Patrick Denard
- Orthopedic SurgeryOregon Shoulder Institute at Southern Oregon Orthopedics
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12
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Kunkle BF, Baxter NA, Welsh ME, Friedman RJ, Eichinger JK. Identification of Independent Predictors of Increased 90-Day Complication and Revision Rates Following Total Elbow Arthroplasty. J Shoulder Elb Arthroplast 2023; 7:24715492231152146. [PMID: 36727143 PMCID: PMC9884946 DOI: 10.1177/24715492231152146] [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: 08/03/2022] [Revised: 11/17/2022] [Accepted: 01/05/2023] [Indexed: 01/28/2023] Open
Abstract
Introduction Total elbow arthroplasty (TEA) is an increasingly popular surgical option for many debilitating conditions of the elbow. There currently exists a paucity of literature regarding patient and hospital factors that lead to inferior outcomes following TEA. The purpose of this study is to identify independent predictors of increased complication and revision rates following TEA. Methods The National Readmissions Database (NRD) was queried from 2011 to 2018 to identify all cases of TEA (n = 8932). Relevant patient demographic factors, comorbidities, and hospital characteristics were identified and run in a univariate binomial logistic regression model. All significant variables were included in a multivariate binomial logistic regression model for data analysis. Results Independent predictors of increased complication rates included age, female sex, Medicare and Medicaid payer status, medium bed-sized center, and 18 of 34 medical comorbidities (all P < .05). Independent predictors of increased revision rates included medium bed-sized centers, non-teaching hospital status, chronic pulmonary disease, depression, and pulmonary circulatory disorders (all P < .05). Conclusion This study identified several patient and hospital characteristics that are independently associated with both increased complication and revision rates following TEA. This information can aid orthopedic surgeons during shared decision making when considering TEA in patients. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Bryce F Kunkle
- Medical University of South
Carolina, Charleston, SC, USA
| | | | - Megan E Welsh
- Medical University of South
Carolina, Charleston, SC, USA
| | | | - Josef K Eichinger
- Medical University of South
Carolina, Charleston, SC, USA,Josef K. Eichinger, Medical University of
South Carolina, 96 Jonathan Lucas St., CSB 708, Charleston, SC 29425, USA.
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13
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Kelly PJ, Twomey-Kozak JN, Goltz DE, Wickman JR, Levin JM, Hinton Z, Lassiter TE, Klifto CS, Anakwenze OA. Perioperative pain control represents the primary concern for patients considering outpatient shoulder arthroplasty: a survey-based study. J Shoulder Elbow Surg 2022; 31:e628-e633. [PMID: 35998781 DOI: 10.1016/j.jse.2022.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/27/2022] [Accepted: 07/07/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Outpatient (OP) total shoulder arthroplasty (TSA) with same-day discharge can now be performed safely in appropriately selected patients. Patient knowledge and perspectives regarding OP TSA are yet unknown and such information may inform surgeon decision-making and provide a framework for addressing patient concerns. The goal of this study was to understand and quantify patient knowledge of and concerns for OP TSA, with a working hypothesis that majority of patients are unaware of OP TSA as a realistic option and that their primary concern would be postoperative pain control. METHODS This was a retrospective cohort study at a tertiary care academic medical center including patients who underwent anatomic or reverse shoulder arthroplasty and completed an OP TSA expectations questionnaire/survey. This survey was provided preoperatively and included demographic factors, self-rated health evaluation, and perioperative expectations. Surveys evaluated whether patients undergoing TSA had any prior awareness of OP TSA and evaluated their primary concern with same-day discharge. Secondary questions included an assessment of patient expectations of outcomes of outpatient vs. inpatient surgery as well as their expected length of inpatient stay. RESULTS A total of 122 patients who underwent anatomic and reverse shoulder arthroplasty completed the questionnaire and comprised the study cohort. Fifty-two (42.6%) of the patients were unaware that OP TSA was an option, and 26 (50%) of these were comfortable with the idea of OP TSA. Comfort with OP TSA was significantly associated with higher subjective patient-reported health status. Fifty-eight patients (47.5%) expected that following TSA they would require <24 hours of in-hospital postoperative care. The primary concern for patients considering OP TSA was postoperative pain control, endorsed by 44.3% of patients, compared with 13.1% of patients stating this would be their primary concern if admitted as an inpatient postoperatively. Pain control being a primary concern was significantly different between those considering outpatient vs. inpatient TSA. Most patients anticipated that OP shoulder arthroplasty would lead to a better (36%) or comparable (53%) outcome, whereas only 11% had concerns that it would lead to a worse outcome. CONCLUSION Expanding OP TSA crucially depends on awareness and education. Perceived ability to control pain is an important concern. Patients may benefit from preoperative counseling, including emphasizing a comprehensive postoperative pain management strategy.
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Affiliation(s)
- Patrick J Kelly
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.
| | | | - Daniel E Goltz
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - John R Wickman
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Jay M Levin
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Zoe Hinton
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Tally E Lassiter
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | | | - Oke A Anakwenze
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
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14
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Goltz DE, Burnett RA, Levin JM, Helmkamp JK, Wickman JR, Hinton ZW, Howell CB, Green CL, Simmons JA, Nicholson GP, Verma NN, Lassiter TE, Anakwenze OA, Garrigues GE, Klifto CS. A validated preoperative risk prediction tool for extended inpatient length of stay following anatomic or reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2022; 32:1032-1042. [PMID: 36400342 DOI: 10.1016/j.jse.2022.10.016] [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: 08/15/2022] [Revised: 10/08/2022] [Accepted: 10/12/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recent work has shown inpatient length of stay (LOS) following shoulder arthroplasty to hold the second strongest association with overall cost (after implant cost itself). In particular, a preoperative understanding for the patients at risk of extended inpatient stays (≥3 days) can allow for counseling, optimization, and anticipating postoperative adverse events. METHODS A multicenter retrospective review was performed of 5410 anatomic (52%) and reverse (48%) total shoulder arthroplasties done at 2 large, tertiary referral health systems. The primary outcome was extended inpatient LOS of at least 3 days, and over 40 preoperative sociodemographic and comorbidity factors were tested for their predictive ability in a multivariable logistic regression model based on the patient cohort from institution 1 (derivation, N = 1773). External validation was performed using the patient cohort from institution 2 (validation, N = 3637), including area under the receiver operator characteristic curve (AUC), sensitivity, specificity, and positive and negative predictive values. RESULTS A total of 814 patients, including 318 patients (18%) in the derivation cohort and 496 patients (14%) in the validation cohort, experienced an extended inpatient LOS of at least 3 days. Four hundred forty-five (55%) were discharged to a skilled nursing or rehabilitation facility. Following parameter selection, a multivariable logistic regression model based on the derivation cohort (institution 1) demonstrated excellent preliminary accuracy (AUC: 0.826), with minimal decrease in accuracy under external validation when tested against the patients from institution 2 (AUC: 0.816). The predictive model was composed of only preoperative factors, in descending predictive importance as follows: age, marital status, fracture case, ASA (American Society of Anesthesiologists) score, paralysis, electrolyte disorder, body mass index, gender, neurologic disease, coagulation deficiency, diabetes, chronic pulmonary disease, peripheral vascular disease, alcohol dependence, psychoses, smoking status, and revision case. CONCLUSION A freely-available, preoperative online clinical decision tool for extended inpatient LOS (≥ 3 days) after shoulder arthroplasty reaches excellent predictive accuracy under external validation. As a result, this tool merits consideration for clinical implementation, as many risk factors are potentially modifiable as part of a preoperative optimization strategy.
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Affiliation(s)
- Daniel E Goltz
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Robert A Burnett
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Jay M Levin
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Joshua K Helmkamp
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - John R Wickman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Zoe W Hinton
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Claire B Howell
- Performance Services, Duke University Medical Center, Durham, NC, USA
| | - Cynthia L Green
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, USA
| | - J Alan Simmons
- Rush Research Core, Rush University Medical Center, Chicago, IL, USA
| | - Gregory P Nicholson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Tally E Lassiter
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Oke A Anakwenze
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Grant E Garrigues
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Christopher S Klifto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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15
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Testa EJ, Lemme NJ, Li LT, DeFroda S. Trends in operative duration of total shoulder arthroplasty from 2008 to 2018: a national database study. Shoulder Elbow 2022; 14:534-543. [PMID: 36199510 PMCID: PMC9527484 DOI: 10.1177/17585732211008900] [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: 03/18/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 01/17/2023]
Abstract
Background As total shoulder arthroplasty has emerged as the fastest growing joint replacement performed, optimizing surgical efficiency and patient outcomes is essential. The goals of the current study were to identify trends and factors affecting the operative time of total shoulder arthroplasty over a 10-year period. Methods The National Surgical Quality Improvement Program database was analyzed to determine the operative time and 30-day complications of total shoulder arthroplasty from 2008 to 2018. Factors affecting total shoulder arthroplasty operative time were also assessed. Multivariable linear regression was used to analyze operative time over years studied while controlling for patient demographics and comorbidities. Results A total of 20,587 total shoulder arthroplasty cases from 2008 to 2018 were included. Mean operative time in 2008 was 139.0 min, while in 2018, mean operative time decreased to 105.6 min (P < .001). Male sex, outpatient surgery, increased body mass index, and low preoperative hematocrit were associated with longer operative times, while elevated international normalized ratio, resident involvement, and elective surgeries were associated with decreased operative duration. Discussion Operative time for total shoulder arthroplasty has decreased from 2008 to 2018. Patient factors and comorbidities are associated with operative time, and such factors are important to consider in operative planning to ensure appropriate patient and surgeon expectations.
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Affiliation(s)
- Edward J Testa
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Nicholas J Lemme
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Lambert T Li
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Steven DeFroda
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
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16
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Puzzitiello RN, Moverman MA, Pagani NR, Menendez ME, Salzler MJ. Current Status Regarding the Safety of Inpatient Versus Outpatient Total Shoulder Arthroplasty: A Systematic Review. HSS J 2022; 18:428-438. [PMID: 35846253 PMCID: PMC9247601 DOI: 10.1177/15563316211019398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/27/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgeons have begun to transition total shoulder arthroplasty (TSA) to the outpatient setting in order to contain costs and reallocate resources. PURPOSE The purpose of this systematic review was to evaluate the safety and cost of outpatient TSA by assessing associated complication rates, clinical outcomes, and total treatment charges. METHODS The MEDLINE, Embase, and Cochrane Library online databases were queried in March 2020 for studies on outpatient shoulder arthroplasty. Inclusion criteria were (1) a study population undergoing TSA, (2) discharge on the day of surgery, and (3) inclusion of at least 1 reported outcome. RESULTS Of 20 studies identified that met inclusion criteria, 14 were comparative studies involving an inpatient control group, 2 of which were matched by age and comorbidities. The remaining studies used control groups consisting of inpatient TSAs who were older or more medically infirm according to American Society of Anesthesiologists (ASA) or Charlson Comorbidity Index (CCI) scores. The combined average age of the outpatient and inpatient groups was 66.5 and 70.1 years, respectively. Patients who underwent outpatient TSA had similar rates of readmissions, emergency department visits, and perioperative complications in comparison to inpatients. Patients also reported comparably high levels of satisfaction with outpatient procedures. Four economic analyses demonstrated substantial cost savings with outpatient TSA in comparison to inpatient surgery. CONCLUSION In carefully selected patients, outpatient TSA appears to be equally safe but less resource intensive than inpatient arthroplasty. Nonetheless, there remains a need for larger prospective studies to decisively characterize the relative safety of outpatient TSA among patients with similar baseline health.
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Affiliation(s)
- Richard N. Puzzitiello
- Department of Orthopaedic Surgery,
Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA,Richard N. Puzzitiello, MD, Department of
Orthopaedic Surgery, Tufts Medical Center, Tufts University School of Medicine,
Boston, MA 02111, USA.
| | - Michael A. Moverman
- Department of Orthopaedic Surgery,
Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Nicholas R. Pagani
- Department of Orthopaedic Surgery,
Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Mariano E. Menendez
- Department of Orthopaedic Surgery,
Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Matthew J. Salzler
- Department of Orthopaedic Surgery,
Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
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Aetiologies and Risk Factors of Prolonged Fever Admission in Samtse Hospital, Bhutan, 2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137859. [PMID: 35805518 PMCID: PMC9266161 DOI: 10.3390/ijerph19137859] [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] [Received: 05/19/2022] [Revised: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 12/10/2022]
Abstract
Febrile illness is a common cause of hospital admission in developing countries, including Bhutan. Prolonged fever admission can add considerable strain on healthcare service delivery. Therefore, identifying the underlying cause of prolonged hospital stays can improve the quality of patient care by providing appropriate empirical treatment. Thus, the study’s aims were to evaluate the aetiologies and factors of prolonged fever admission in Samtse Hospital, Bhutan. Fever admission data from 1 January to 31 December 2020 were retrieved from the Samtse Hospital database. Prolonged hospital stay was defined as those with >5 days of hospital admission. Univariable and multivariable logistic regression was used to identify risk factors for a prolonged hospital stay. Of 290 records, 135 (46.6%) were children (≤12 years), 167 (57.6%) were males, and 237 (81.7%) patients were from rural areas. The common aetiologies for fever admissions were respiratory tract infection (85, 29.3%) and acute undifferentiated febrile illness (48, 16.6%). The prolonged stay was reported in 87 (30.0%) patients. Patients from rural areas (adjusted odds ratio [AOR] = 4.02, 95% CI = 1.58−10.24) and those with respiratory tract infections (AOR = 5.30, 95% CI = 1.11−25.39) and urinary tract infections and kidney disease (AOR = 8.16, 95% CI = 1.33−49.96) had higher odds of prolonged hospital stay. This epidemiological knowledge on prolonged hospital stay can be used by the physician for the management of fever admission in Samtse Hospital.
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18
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Milto AJ, El Bitar Y, Scaife SL, Thuppal S. Differences in hospital length of stay and total hospital charge by income level in patients hospitalized for hip fractures. Osteoporos Int 2022; 33:1067-1078. [PMID: 34988626 PMCID: PMC8731208 DOI: 10.1007/s00198-021-06260-3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/01/2021] [Indexed: 12/15/2022]
Abstract
UNLABELLED This study examines the difference in length of stay and total hospital charge by income quartile in hip fracture patients. The length of stay increased in lower income groups, while total charge demonstrated a U-shaped relationship, with the highest charges in the highest and lowest income quartiles. INTRODUCTION Socioeconomic factors have an impact on outcomes in hip fracture patients. This study aims to determine if there is a difference in hospital length of stay (LOS) and total hospital charge between income quartiles in hospitalized hip fracture patients. METHODS National Inpatient Sample (NIS) data from 2016 to 2018 was used to determine differences in LOS, total charge, and other demographic/clinical outcomes by income quartile in patients hospitalized for hip fracture. Multivariate regressions were performed for both LOS and total hospital charge to determine variable impact and significance. RESULTS There were 860,045 hip fracture patients were included this study. With 222,625 in the lowest income quartile, 234,215 in the second, 215,270 in the third, and 190,395 in the highest income quartile. LOS decreased with increase in income quartile. Total charge was highest in the highest quartile, while it was lowest in the middle two-quartiles. Comorbidities with the largest magnitude of effect on both LOS and total charge were lung disease, kidney disease, and heart disease. Time to surgery post-admission also had a large effect on both outcomes of interest. CONCLUSION The results demonstrate that income quartile has an effect on both hospital LOS and total charge. This may be the result of differences in demographics and other clinical variables between quartiles and increased comorbidities in lower income levels. The overall summation of these socioeconomic, demographic, and medical factors affecting patients in lower income levels may result in worse outcomes following hip fracture.
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Affiliation(s)
- Anthony J Milto
- Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, P.O. Box 19679, Springfield, IL, 62794, USA
- Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St, Springfield, IL, 62702, USA
| | - Youssef El Bitar
- Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, P.O. Box 19679, Springfield, IL, 62794, USA
| | - Steven L Scaife
- Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St, Springfield, IL, 62702, USA
| | - Sowmyanarayanan Thuppal
- Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, P.O. Box 19679, Springfield, IL, 62794, USA.
- Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St, Springfield, IL, 62702, USA.
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Rovers MM, Wijn SRW, Grutters JPC, Metsemakers SJJPM, Vermeulen RJ, van der Pennen R, Berden BJJM, Gooszen HG, Scholte M, Govers TM. Development of a decision analytical framework to prioritise operating room capacity: lessons learnt from an empirical example on delayed elective surgeries during the COVID-19 pandemic in a hospital in the Netherlands. BMJ Open 2022; 12:e054110. [PMID: 35396284 PMCID: PMC8995574 DOI: 10.1136/bmjopen-2021-054110] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To develop a prioritisation framework to support priority setting for elective surgeries after COVID-19 based on the impact on patient well-being and cost. DESIGN We developed decision analytical models to estimate the consequences of delayed elective surgical procedures (eg, total hip replacement, bariatric surgery or septoplasty). SETTING The framework was applied to a large hospital in the Netherlands. OUTCOME MEASURES Quality measures impacts on quality of life and costs were taken into account and combined to calculate net monetary losses per week delay, which quantifies the total loss for society expressed in monetary terms. Net monetary losses were weighted by operating times. RESULTS We studied 13 common elective procedures from four specialties. Highest loss in quality of life due to delayed surgery was found for total hip replacement (utility loss of 0.27, ie, 99 days lost in perfect health); the lowest for arthroscopic partial meniscectomy (utility loss of 0.05, ie, 18 days lost in perfect health). Costs of surgical delay per patient were highest for bariatric surgery (€31/pp per week) and lowest for arthroscopic partial meniscectomy (-€2/pp per week). Weighted by operating room (OR) time bariatric surgery provides most value (€1.19/pp per OR minute) and arthroscopic partial meniscectomy provides the least value (€0.34/pp per OR minute). In a large hospital the net monetary loss due to prolonged waiting times was €700 840 after the first COVID-19 wave, an increase of 506% compared with the year before. CONCLUSIONS This surgical prioritisation framework can be tailored to specific centres and countries to support priority setting for delayed elective operations during and after the COVID-19 pandemic, both in and between surgical disciplines. In the long-term, the framework can contribute to the efficient distribution of OR time and will therefore add to the discussion on appropriate use of healthcare budgets. The online framework can be accessed via: https://stanwijn.shinyapps.io/priORitize/.
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Affiliation(s)
- Maroeska M Rovers
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Stan RW Wijn
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Janneke PC Grutters
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Sanne JJPM Metsemakers
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Robin J Vermeulen
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Ron van der Pennen
- Elisabeth-TweeSteden Ziekenhuis, Tilburg, Noord-Brabant, The Netherlands
| | - Bart JJM Berden
- Elisabeth-TweeSteden Ziekenhuis, Tilburg, Noord-Brabant, The Netherlands
- IQ healthcare, Radboud Insititute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hein G Gooszen
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Mirre Scholte
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Tim M Govers
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
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20
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Prior Nonshoulder Periprosthetic Joint Infection Increases the Risk of Surgical Site Infection, Sepsis, and All-Cause Revision After Primary Total Shoulder Arthroplasty. J Am Acad Orthop Surg 2022; 30:133-139. [PMID: 34921545 DOI: 10.5435/jaaos-d-21-00745] [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: 07/26/2021] [Accepted: 11/03/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Periprosthetic joint infection (PJI) after total joint arthroplasty is a known risk factor for infection in subsequent joint arthroplasty. The purpose of this study was to determine whether prior nonshoulder PJI contributes to the increased risk of infectious complications, greater healthcare utilization, and increased revision surgery after primary total shoulder arthroplasty (TSA). METHODS Patients who underwent primary TSA for osteoarthritis with prior nonshoulder PJI were identified in a national database (PearlDiver Technologies) using Current Procedural Terminology and International Classification of Diseases codes. These patients were propensity matched based on age, sex, Charlson Comorbidity Index, smoking status, and obesity (body mass index >30 kg/m2) to a control cohort of patients who underwent primary TSA for osteoarthritis without any prior PJI. Primary outcomes include 1- and 2-year revision rates. Secondary outcomes include healthcare-specific outcomes of readmission, emergency department visits, length of stay, and mortality. Bivariate analysis was conducted using chi-square tests to compare all outcomes and complications between both cohorts. RESULTS Compared with patients without prior PJI, those with prior PJI had a significantly higher risk of 90-day surgical site infection (7.61% versus 0.56%) and sepsis (1.79% versus 0.56%) after TSA (P < 0.05 for both). Patients with prior PJI also had a higher risk of 90-day readmission compared with those without prior PJI (3.36% versus 1.23%, P = 0.008). In terms of surgical complications, patients with prior PJI had significantly higher risk of 2-year revision surgery compared with patients without prior PJI (3.36% versus 1.57%, P = 0.034). CONCLUSION Prior nonshoulder PJI of any joint increases rates of 90-day surgical site infection, sepsis, and hospital readmission, as well as 2-year all-cause revision after TSA. These results are important for risk-stratifying patients undergoing TSA with prior history of PJI. LEVEL OF EVIDENCE III.
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21
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Magone KM, Ben-Ari E, Gordan D, Pines Y, Boin MA, Kwon YW, Zuckerman JD, Virk MS. Analysis of Patient’s Willingness and Concerns for Discharge Following Shoulder Arthroplasty. JSES Int 2022; 6:429-433. [PMID: 35572437 PMCID: PMC9091749 DOI: 10.1016/j.jseint.2021.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Patient's willingness and barriers for discharge after shoulder arthroplasty (SA) has not been studied. The aim of this study was to prospectively analyze patient's willingness for discharge and barriers to discharge beyond postoperative day #1 (POD#1) after SA. Methods In this prospective study, patients undergoing primary or revision SA (anatomic, reverse, or hemiarthroplasty) at our institution were enrolled to determine their willingness and concerns for discharge after SA. Patient's willingness for discharge was inquired daily until discharge. Demographic information, patient's medical history, intraoperative details (duration of surgery, estimated blood loss, intraoperative complication), discharge disposition, length of stay (LOS), and reasons for extension of LOS beyond POD#1 were analyzed. Results A total of 184 patients who underwent SA were included. Eight patients were discharged on POD#0, 114 patients on POD#1, 37 patients on POD#2, and 25 patients after POD#2. One hundred nineteen (119) patients were discharged to home, 40 were discharged to home with services, 15 were discharged to nursing facilities, and 10 were discharged to rehabilitation centers. Reasons for extension of LOS past POD#1 included patients failing to clear home safety evaluation (n = 4), inadequate pain control (n = 6), worsening of preexisting medical conditions (n = 8), delay in patient disposition (awaiting placement in a rehabilitation facility [n = 6] and awaiting culture results [n = 9]). Social reasons (n = 29) were the most common reasons for extension of LOS. These included patients requesting an extra day of stay (n = 20), patients requesting rehabilitation facility placement (n = 5), lack of a timely ride home (n = 2), and family-related reasons (death in the family [n = 1], lack of home help [n = 1]). Conclusions This prospective study demonstrates modifiable factors associated with LOS beyond POD#1 (inadequate pain control, logistic delays in disposition, and patient-related social concerns) after SA. With increasing interest in same-day discharge and rising concerns to control cost and use bundled payment initiatives with SA, improving patient's willingness to discharge by addressing their concerns can improve early discharge after SA.
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Affiliation(s)
- Kevin M. Magone
- 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
| | - Erel Ben-Ari
- 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
- Division of Orthopaedic Surgery, Tel-Hashomer “Sheba” Medical Center, Sackler School of Medicine, Ramat Gan, Israel
| | - Dan Gordan
- 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
| | - Yaniv Pines
- 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
| | - Michael A. Boin
- 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
| | - Young W. Kwon
- 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
| | - Joseph D. Zuckerman
- 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
- Corresponding author: Mandeep S. Virk, MD, 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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22
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MacLean IS, Lu Y, Patel BH, Agarwalla A, Nolte MT, Lavoie-Gagne O, Romeo AA, Forsythe B. A Risk Stratification Nomogram to Predict Inpatient Admissions After Total Shoulder Arthroplasty Among Patients Eligible for Medicare. Orthopedics 2022; 45:43-49. [PMID: 34734779 DOI: 10.3928/01477447-20211101-09] [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] [Indexed: 02/05/2023]
Abstract
The goal of this study was to establish a risk stratification nomogram to aid in determining the need for inpatient admission among patients who were eligible for Medicare and were undergoing primary total shoulder arthroplasty (TSA). The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify all patients older than 65 years who underwent primary TSA between 2006 and 2016. The primary outcome measure was inpatient admission, as defined by hospital length of stay longer than 2 days. Multiple demographic, comorbid, and peri-operative variables were used in a multivariate logistic regression model to yield a risk stratification nomogram. A total of 1514 inpatient and 6020 out-patient admissions were analyzed. Age older than 80 years (odds ratio [OR], 2.69; P<.0001; 95% CI, 2.21-3.27), female sex (OR, 2.18; P<.0001; 95% CI, 1.90-2.51), dependent functional status (OR, 1.69; P<.0001; 95% CI, 1.2-2.38), dialysis (OR, 3.48; P=.029; 95% CI, 1.14-10.63), admission from an inpatient facility (OR, 1.76; P<.0001; 95% CI, 1.70-1.82), and inflammatory arthritis (OR, 1.69; P<.02; 95% CI, 1.25-13.78) were the greatest determinants of inpatient stay. The resulting predictive model showed acceptable discrimination and calibration. Our model enabled reliable and straightforward identification of the most suitable candidates for inpatient admission among patients who were eligible for Medicare and were undergoing primary TSA. Patients who were receiving dialysis, who had dyspnea at rest, and who had bleeding disorders were more likely to be admitted as inpatients after TSA. Larger multicenter studies are necessary to externally validate the proposed predictive nomogram. [Orthopedics. 2022;45(1):43-49.].
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Hung NJ, Wong SE. Gender Influences on Shoulder Arthroplasty. Curr Rev Musculoskelet Med 2022; 15:21-26. [PMID: 34982405 PMCID: PMC8804121 DOI: 10.1007/s12178-021-09737-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW As the incidence of shoulder arthroplasty continues to increase, there is growing interest in patient-based factors that may predict outcomes. Based on existing literature demonstrating gender-based disparities following total hip and knee arthroplasty, gender may also influence shoulder arthroplasty. The purpose of this review is to discuss the recent literature on the influence of gender on shoulder arthroplasty, focusing on differences in preoperative parameters, perioperative complications, and postoperative outcomes. RECENT FINDINGS While both female and male patients generally benefit from shoulder arthroplasty, several differences may exist in preoperative factors, acute perioperative complications, and postoperative outcomes. Preoperatively, female patients undergo shoulder arthroplasty at an older age compared to their male counterparts. They may also have greater levels of preoperative disability and different preoperative expectations. Perioperatively, female patients may be at increased risk of extended length of stay, postoperative thromboembolic events, and blood transfusion. Postoperatively, female patients may achieve lower postoperative functional scores and decreased range of motion compared to male patients. Differences in postoperative functional scores may be influenced by gender-based differences in activities of daily living. Finally, female patients may be at greater risk for periprosthetic fracture and aseptic loosening while male patients appear to be at greater risk for periprosthetic infection and revision surgery. Current literature on the influence of gender on shoulder arthroplasty is limited and conflicting. Further research is necessary to delineate how gender affects patients at the pre- and postoperative levels to better inform decision-making and outcomes.
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Affiliation(s)
- Nicole J Hung
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Stephanie E Wong
- Department of Orthopaedic Surgery, University of California, San Francisco, 1500 Owens Street, San Francisco, CA, 94158, USA.
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Wang KC, Patel AV, White CA, Gross BD, Parsons BO, Cagle PJ. Efeito da COVID-19 na artroplastia de ombro em um centro médico terciário na cidade de Nova York. Rev Bras Ortop 2021; 58:121-126. [PMID: 36969784 PMCID: PMC10038706 DOI: 10.1055/s-0041-1735950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022] Open
Abstract
Resumo
Objetivo A pandemia de COVID-19 causou uma pausa sem precedentes em cirurgias eletivas, inclusive artroplastia de ombro. Procuramos determinar as possíveis diferenças clínicas e/ou demográficas entre os pacientes que realizaram artroplastia de ombro durante a pandemia em comparação com o ano anterior (2019).
Métodos Os registros institucionais foram consultados para obtenção de informações sobre pacientes submetidos a artroplastia de ombro entre 1° de março a 1° de julho de 2019 e 2020. Dados demográficos, amplitude de movimento, duração da cirurgia, tempo de hospitalização, condições à alta e manejo pós-operatório foram analisados.
Resultados O tempo médio de cirurgia foi de 160 ± 50 minutos em 2020 e de 179 ± 54 minutos em 2019 (p = 0,13). O tempo médio de internação foi de 36 ± 13 horas em 2020 e de 51 ± 40 horas em 2019 (p = 0,04). Em 2019, 96% dos pacientes fizeram fisioterapia, enquanto 71% o fizeram em 2020 (p = 0,003). Todos os pacientes de 2019 e 86% dos pacientes de 2020 participaram do acompanhamento pós-operatório presencial (p = 0,006). Os pacientes de 2019 retornaram para a consulta médica em média 14 ± 11 dias após a cirurgia; os pacientes de 2020 retornaram para o acompanhamento em 25 ± 25 dias (p = 0,10). A amplitude de movimento, a idade, a pontuação da American Society of Anesthesiologists (ASA, na sigla em inglês) e as taxas de complicações não diferiram entre as coortes.
Conclusão Os pacientes submetidos a cirurgia na fase inicial da pandemia eram demográfica e clinicamente semelhantes aos pacientes de 2019. No entanto, o tempo de internação diminuiu de forma significativa durante a pandemia de COVID-19. O acompanhamento pós-operatório e a fisioterapia foram adiados em 2020, mas isso não levou a diferenças nas taxas de complicações ou de reinternações em comparação às da coorte de 2019.
Nível de Evidência III.
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Affiliation(s)
- Kevin C. Wang
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, New York City, New York, Estados Unidos
| | - Akshar V. Patel
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, New York City, New York, Estados Unidos
| | - Christopher A. White
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, New York City, New York, Estados Unidos
| | - Benjamin D. Gross
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, New York City, New York, Estados Unidos
| | - Bradford O. Parsons
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, New York City, New York, Estados Unidos
| | - Paul J. Cagle
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, New York City, New York, Estados Unidos
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25
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Moellhoff N, Broer PN, Heidekrueger PI, Ninkovic M, Ehrl D. Impact of patients' gender on microvascular lower extremity reconstruction. J Plast Surg Hand Surg 2021; 56:47-52. [PMID: 34292803 DOI: 10.1080/2000656x.2021.1914638] [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] [Indexed: 10/20/2022]
Abstract
The physiological differences between genders have significant implications for health and disease. With regard to microsurgery, results remain elusive as to whether male or female gender is an independent risk factor for free flap reconstruction. This study evaluated the impact of gender on outcomes of lower-extremity free-flap reconstructions. Within 7 years, 358 patients received 393 microvascular lower limb free flap reconstructions. The cases were divided into two groups according to patients' gender: male vs. female. Retrospective data analysis evaluated patients' demographics, perioperative details, surgical complications and flap outcomes over a 3-month follow-up period. Major and minor surgical complications, including total and partial flap loss, showed no significant differences between the investigated groups (p>.05). In addition, there was no significant difference with regard to the rate of surgical revision surgery, or the incidence of arterial and venous thrombosis (p>.05). Comparison of different flap types (fasciocutaneous ALT vs. gracilis muscle flaps) and type of anastomosis (end-to-end vs. end-to-side) also revealed no difference in outcomes in respect to gender. In conclusion, gender cannot be regarded as an independent risk factor for free flap reconstructions in patients with lower-extremity defects.
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Affiliation(s)
- Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - P Niclas Broer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany
| | - Paul I Heidekrueger
- Department of Plastic, Hand, and Reconstructive Surgery, University Medical Center, Regensburg, Germany
| | - Milomir Ninkovic
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany
| | - Denis Ehrl
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
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Harris AB, Best MJ, Weiner S, Gupta HO, Jenkins SG, Srikumaran U. Hospital Readmission Rates Following Outpatient Versus Inpatient Shoulder Arthroplasty. Orthopedics 2021; 44:e173-e177. [PMID: 33002176 DOI: 10.3928/01477447-20200925-03] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Outpatient total shoulder arthroplasty (TSA) is an alternative to surgery with inpatient admission for appropriate patients. Controlled studies assessing differences in perioperative outcomes between inpatient and outpatient TSA are lacking. In this study, the primary outcome was 30-day all-cause hospital readmission following inpatient vs outpatient TSA. The National Surgical Quality Improvement Program (NSQIP) database was used to identify patients undergoing both primary and revision TSA from 2010 to 2017. Patients were identified using Current Procedural Terminology codes. A 1:1 propensity score matching was used to create two groups of patients, those who underwent outpatient surgery and those who underwent inpatient surgery, while matching for age, sex, American Society of Anesthesiologists classification, primary vs revision surgery, smoking, diabetes, chronic obstructive pulmonary disease, and congestive heart failure. This study had a power of 85% to detect a difference of 1% in 30-day readmission. Following 1:1 propensity score matching, 1714 patients who underwent inpatient TSA and 1714 patients who underwent outpatient TSA were analyzed. All-cause 30-day readmission rates were 3.4% in the outpatient group and 1.7% in the inpatient group (P<.01). A total of 1.9% of patients who underwent outpatient surgery had a 30-day readmission for a surgical complication compared with 1.4% of patients who underwent inpatient surgery (P=.32). Although patients who underwent outpatient TSA had an increased risk of all-cause 30-day readmission compared with equally matched controls who underwent inpatient TSA, readmission for surgical complications was equivalent between the two groups. Careful patient selection for outpatient TSA should be emphasized to minimize the potential for postoperative hospital admission. [Orthopedics. 2021;44(2):e173-e178.].
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Huddleston HP, Mehta N, Polce EM, Williams BT, Fu MC, Yanke AB, Verma NN. Complication rates and outcomes after outpatient shoulder arthroplasty: a systematic review. JSES Int 2021; 5:413-423. [PMID: 34136848 PMCID: PMC8178605 DOI: 10.1016/j.jseint.2020.11.005] [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] [Indexed: 12/25/2022] Open
Abstract
Background As the number of total shoulder arthroplasties (TSAs) performed annually increases, some surgeons have begun to shift toward performing TSAs in the outpatient setting. However, it is imperative to establish the safety of outpatient TSA. The purpose of this systematic review was to define complication, readmission, and reoperation rates and patient-reported outcomes after outpatient TSA. Methods A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using three databases (PubMed, Ovid, and Embase). English-language publications describing results on complication rates in patients who underwent TSA in an outpatient or ambulatory setting were included. All nonclinical and deidentified database studies were excluded. Bias assessment was conducted with the methodologic index for nonrandomized studies criteria. Results Seven studies describing outcomes in outpatient TSA were identified for inclusion. The included studies used varying criteria for selecting patients for an outpatient procedure. The total outpatient 90-day complication rate (commonly including hematomas, wound issues, and nerve palsies) ranged from 7.1%-11.5%. Readmission rates ranged from 0%-3.7%, and emergency and urgent care visits ranged from 2.4%-16.1%. Patient-reported outcomes improved significantly after outpatient TSA in all studies. Two studies found a higher complication rate in the comparative inpatient cohort (P = .023-.027). Methodologic index for nonrandomized studies scores ranged from 9 to 11 (of 16) for noncomparative studies (n = 3), while all comparative studies received a score of a 16 (of 24). Conclusion Outpatient TSA in properly selected patients results in a similar complication rate to inpatient TSA. Further studies are needed to aid in determining proper risk stratification to direct patients to inpatient or outpatient shoulder arthroplasty.
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Affiliation(s)
| | - Nabil Mehta
- Rush University Medical Center, Chicago, IL, USA
| | - Evan M Polce
- Rush University Medical Center, Chicago, IL, USA
| | | | - Michael C Fu
- Rush University Medical Center, Chicago, IL, USA
| | - Adam B Yanke
- Rush University Medical Center, Chicago, IL, USA
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Cointat C, Gauci MO, Azar M, Tran L, Trojani C, Boileau P. Outpatient shoulder prostheses: Feasibility, acceptance and safety. Orthop Traumatol Surg Res 2021; 107:102913. [PMID: 33798792 DOI: 10.1016/j.otsr.2021.102913] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 10/11/2020] [Accepted: 10/26/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Outpatient surgery in France is defined by the national authority for health (HAS) as a scheduled surgery enabling same-day discharge without any increased risk to the patient. With the advent of enhanced recovery after surgery, outpatient lower limb arthroplasty has become a common procedure. However, only 1.1% of knee arthroplasties in France were performed on an outpatient basis in 2017. OBJECTIVES 1) assess early morbidity and mortality after outpatient shoulder arthroplasties to validate eligibility and safety criteria; and 2) assess patient acceptance of outpatient surgery. METHODS A single-center study with the following inclusion criteria: primary shoulder arthroplasty, American Society of Anesthesiology (ASA) score I or II, no cognitive impairment, and no coronary artery or thromboembolic diseases. Analgesia was provided by bupivacaine via a peripheral nerve catheter in the first 72 hours followed by oral analgesics. Patients were discharged if the post-anesthetic discharge scoring system (PADSS) was>9/10 and the visual analog scale (VAS) was<5/10. Postoperative telephone interviews were carried out on D1, D2 and D3 to assess pain with the numerical rating scale and to collect data on their analgesic consumption. All patients were seen by an independent observer at one and six months for a clinical and radiologic follow-up and at 90 days during a consultation with the senior surgeon. The primary endpoint was the 90-day morbidity and mortality rate (readmissions, rehospitalizations, and minor and major complications). A satisfaction questionnaire was collected at one and six months. RESULTS Thirty-six patients were offered an outpatient shoulder arthroplasty between February 2016 and February 2018: 12 (33%) refused with no valid reasons and 24 patients agreed to the procedure (seven hemiarthroplasties, nine anatomic shoulder arthroplasties and eight reverse shoulder arthroplasties). The mean age at surgery was 70 years (55-82), mean body mass index (BMI) was 26 (21-32) and 14 patients were ASA II (66%). Three patients (12%) refused same-day discharge despite a PADSS score>9/10 and adequate pain management. Two patients (8%) were not discharged home on the same day as the surgery for medical reasons (one for pain and one for high blood pressure). No readmissions or complications were reported for the 19 outpatient arthroplasties. None of the outpatients used opioids. All patients were satisfied with their functional outcome, 84% were satisfied with the outpatient management and 17% felt they were insufficiently monitored and regretted that they were not hospitalized. CONCLUSIONS 1) outpatient shoulder arthroplasty can be safely proposed to selected patients with low comorbidities, regardless of their age and type of implant; 2) the acceptance rate for outpatient shoulder arthroplasty remained low among our patient population. These results should incite us to better educate patients about outpatient surgery. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Caroline Cointat
- Unité de recherche clinique Côte d'Azur (UR2CA), service de chirurgie orthopédique et chirurgie du sport, institut universitaire locomoteur et du sport (iULS), CHU de Nice, hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France
| | - Marc Olivier Gauci
- Unité de recherche clinique Côte d'Azur (UR2CA), service de chirurgie orthopédique et chirurgie du sport, institut universitaire locomoteur et du sport (iULS), CHU de Nice, hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France
| | - Michel Azar
- Unité de recherche clinique Côte d'Azur (UR2CA), service de chirurgie orthopédique et chirurgie du sport, institut universitaire locomoteur et du sport (iULS), CHU de Nice, hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France
| | - Laurie Tran
- Service d'anesthésie-réanimation, institut Arnault-Tzanck, 171, rue du Commandant Gaston-Cahuzac, 06700 Saint-Laurent-du-Var, France
| | - Christophe Trojani
- Unité de recherche clinique Côte d'Azur (UR2CA), service de chirurgie orthopédique et chirurgie du sport, institut universitaire locomoteur et du sport (iULS), CHU de Nice, hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France; Groupe Kantys, institut de chirurgie réparatrice locomoteur et du sport (ICR), 7, avenue Durante, 06000 Nice, France
| | - Pascal Boileau
- Unité de recherche clinique Côte d'Azur (UR2CA), service de chirurgie orthopédique et chirurgie du sport, institut universitaire locomoteur et du sport (iULS), CHU de Nice, hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France.
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Vajapey SP, Contreras ES, Neviaser AS, Bishop JY, Cvetanovich GL. Outpatient Total Shoulder Arthroplasty: A Systematic Review Evaluating Outcomes and Cost-Effectiveness. JBJS Rev 2021; 9:01874474-202105000-00002. [PMID: 33956691 DOI: 10.2106/jbjs.rvw.20.00189] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Orthopaedic surgical procedures are increasingly being performed in outpatient settings. The drive for cost reduction without compromising patient safety and outcomes has increased interest in outpatient total shoulder arthroplasty (TSA). The primary aim of this study was to perform a review of the evidence regarding the outcomes and cost-effectiveness of outpatient TSA. METHODS A search of the PubMed, Embase, and Cochrane Library databases was performed using several keywords: "outpatient," "shoulder replacement," "ambulatory," "day case," "day-case," "shoulder arthroplasty," "same day," and "shoulder surgery." Studies that were published from May 2010 to May 2020 in the English language were considered. Research design, questions, and outcomes were recorded for each study. Qualitative and quantitative pooled analysis was performed on the data where appropriate. RESULTS Twenty studies met the inclusion criteria. Six retrospective studies compared complication rates between inpatient and outpatient cohorts and found no significant differences. Four studies found that the complication rate was lower in the outpatient cohort compared with the inpatient cohort. In a pooled analysis, the readmission rate after outpatient TSA was significantly lower than the readmission rate after inpatient TSA at 30 days (0.65% vs. 0.95%) and 90 days (2.03% vs. 2.87%) postoperatively (p < 0.05 for both). Four studies evaluated the cost of outpatient TSA in comparison with inpatient TSA. All of these studies found that TSA at an ambulatory surgery center was significantly less costly than TSA at an inpatient facility, both for the health-care system and for the patient. Patient selection for outpatient TSA may depend on several important factors, including the presence or absence of diabetes, chronic obstructive pulmonary disease, chronic kidney disease, congestive heart failure, poor functional status, higher American Society of Anesthesiologists class, chronic narcotic use, higher body mass index, and older age. CONCLUSIONS Our results show that patient selection is the most critical factor that predicts the success of outpatient TSA. While outpatient TSA is significantly less costly than inpatient TSA, patients undergoing outpatient TSA are more likely to be healthier than patients undergoing inpatient TSA. More high-quality long-term studies are needed to add to this body of evidence. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sravya P Vajapey
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
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30
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Lopez CD, Constant M, Anderson MJJ, Confino JE, Heffernan JT, Jobin CM. Using machine learning methods to predict nonhome discharge after elective total shoulder arthroplasty. JSES Int 2021; 5:692-698. [PMID: 34223417 PMCID: PMC8245980 DOI: 10.1016/j.jseint.2021.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Machine learning has shown potential in accurately predicting outcomes after orthopedic surgery, thereby allowing for improved patient selection, risk stratification, and preoperative planning. This study sought to develop machine learning models to predict nonhome discharge after total shoulder arthroplasty (TSA). Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent elective TSA from 2012 to 2018. Boosted decision tree and artificial neural networks (ANN) machine learning models were developed to predict non-home discharge and 30-day postoperative complications. Model performance was measured using the area under the receiver operating characteristic curve (AUC) and overall accuracy (%). Multivariate binary logistic regression analyses were used to identify variables that were significantly associated with the predicted outcomes. Results There were 21,544 elective TSA cases identified in the National Surgical Quality Improvement Program registry from 2012 to 2018 that met inclusion criteria. Multivariate logistic regression identified several variables associated with increased risk of nonhome discharge including female sex (odds ratio [OR] = 2.83; 95% confidence interval [CI] = 2.53-3.17; P < .001), age older than 70 years (OR = 3.19; 95% CI = 2.86-3.57; P < .001), American Society of Anesthesiologists classification 3 or greater (OR = 2.70; 95% CI = 2.41-2.03; P < .001), prolonged operative time (OR = 1.38; 95% CI = 1.20-1.58; P < .001), as well as history of diabetes (OR = 1.56; 95% CI = 1.38-1.75; P < .001), chronic obstructive pulmonary disease (OR = 1.71; 95% CI = 1.46-2.01; P < .001), congestive heart failure (OR = 2.65; 95% CI = 1.72-4.01; P < .001), hypertension (OR = 1.35; 95% CI = 1.20-1.52; P = .004), dialysis (OR = 3.58; 95% CI = 2.01-6.39; P = .002), wound infection (OR = 5.67; 95% CI = 3.46-9.29; P < .001), steroid use (OR = 1.43; 95% CI = 1.18-1.74; P = .010), and bleeding disorder (OR = 1.84; 95% CI = 1.45-2.34; P < .001). The boosted decision tree model for predicting nonhome discharge had an AUC of 0.788 and an overall accuracy of 90.3%. The ANN model for predicting nonhome discharge had an AUC of 0.851 and an overall accuracy of 89.9%. For predicting the occurrence of 1 or more postoperative complications, the boosted decision tree model had an AUC of 0.795 and an overall accuracy of 95.5%. The ANN model yielded an AUC of 0.788 and an overall accuracy of 92.5%. Conclusions Both the boosted decision tree and ANN models performed well in predicting nonhome discharge with similar overall accuracy, but the ANN had higher discriminative ability. Based on the findings of this study, machine learning has the potential to accurately predict nonhome discharge after elective TSA. Surgeons can use such tools to guide patient expectations and to improve preoperative discharge planning, with the ultimate goal of decreasing hospital length of stay and improving cost-efficiency.
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Affiliation(s)
- Cesar D Lopez
- New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Michael Constant
- New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Matthew J J Anderson
- New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Jamie E Confino
- New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - John T Heffernan
- New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Charles M Jobin
- New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
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Complications and Readmissions After Reverse and Anatomic Total Shoulder Arthroplasty With Same-day Discharge. J Am Acad Orthop Surg 2021; 29:116-122. [PMID: 32501854 DOI: 10.5435/jaaos-d-20-00245] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/01/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Recent studies have demonstrated the safety of anatomic total shoulder arthroplasty (TSA) in an outpatient setting. No clinical studies, to date, have specifically analyzed complication and readmission rates after reverse total shoulder arthroplasty (RTSA) with same-day discharge. The purpose of this study was to compare the 90-day complication and readmission rates of patients undergoing TSA and RTSA with same-day discharge. METHODS Ninety-eight consecutive patients who underwent 104 shoulder arthroplasties with same-day discharge (52 TSA and 52 RTSA) between 2016 and 2019 were analyzed. Suitability for same-day discharge was determined preoperatively using the standardized criteria. Demographic variables, operative time, 90-day readmission, and complication rates were recorded and compared between groups. Differences between the patients undergoing TSA versus RTSA were evaluated with Student t-test, Mann-Whitney test, or Chi square tests as statistically appropriate and reported as P values. RESULTS Average age in the TSA cohort was significantly lower (60.1 ± 7.4 versus 67.5 ± 7.5, respectively; P < 0.001). Total operating room time was significantly shorter in the RTSA cohort (153 ± 30.1 minutes versus 171 ± 20.9). Three minor postoperative complications (5.8%) were observed in the TSA cohort (three seromas) within the 90-day postoperative period. There were four postoperative complications (7.7%) in the RTSA cohort (two postoperative seromas, one periprosthetic fracture, and one dislocation). None of the TSA patients required readmission and 1 RTSA (periprosthetic fracture) patient required readmission within 90 days. DISCUSSION RTSA with same-day discharge is a safe option for appropriately selected patients despite significantly increased age. 90-day readmission and complication rates between outpatient TSA and RTSA are similar. DATA AVAILABILITY Yes. TRIAL REGISTRATION NUMBERS NA. LEVEL OF EVIDENCE III (case-control).
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The Frequency of, and Factors Associated with Prolonged Hospitalization: A Multicentre Study in Victoria, Australia. J Clin Med 2020; 9:jcm9093055. [PMID: 32971851 PMCID: PMC7564707 DOI: 10.3390/jcm9093055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/10/2020] [Accepted: 09/17/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Limited available evidence suggests that a small proportion of inpatients undergo prolonged hospitalization and use a disproportionate number of bed days. Understanding the factors contributing to prolonged hospitalization may improve patient care and reduce the length of stay in such patients. Methods: We undertook a retrospective cohort study of adult (≥20 years) patients admitted for at least 24 h between 14 November 2016 and 14 November 2018 to hospitals in Victoria, Australia. Data including baseline demographics, admitting specialty, survival status and discharge disposition were obtained from the Victorian Admission Episode Dataset. Multivariable logistic regression analysis was used to identify factors independently associated with prolonged hospitalization (≥14 days). Cox proportional hazard regression model was used to examine the association between various factors and in-hospital mortality. Results: There were almost 5 million hospital admissions over two years. After exclusions, 1,696,112 admissions lasting at least 24 h were included. Admissions with prolonged hospitalization comprised only 9.7% of admissions but utilized 44.2% of all hospital bed days. Factors independently associated with prolonged hospitalization included age, female gender, not being in a relationship, being a current smoker, level of co-morbidity, admission from another hospital, admission on the weekend, and the number of admissions in the prior 12 months. The in-hospital mortality rate was 5.0% for those with prolonged hospitalization compared with 1.8% in those without (p < 0.001). Prolonged hospitalization was also independently associated with a decreased likelihood of being discharged to home (OR 0.53, 95% CI 0.52–0.54). Conclusions: Patients experiencing prolonged hospitalization utilize a disproportionate proportion of bed days and are at higher risk of in-hospital death and discharge to destinations other than home. Further studies are required to identify modifiable factors contributing to prolonged hospitalization as well as the quality of end-of-life care in such admissions.
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A Novel Machine Learning Model Developed to Assist in Patient Selection for Outpatient Total Shoulder Arthroplasty. J Am Acad Orthop Surg 2020; 28:e580-e585. [PMID: 31663914 PMCID: PMC7180108 DOI: 10.5435/jaaos-d-19-00395] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Patient selection for outpatient total shoulder arthroplasty (TSA) is important to optimizing patient outcomes. This study aims to develop a machine learning tool that may aid in patient selection for outpatient total should arthroplasty based on medical comorbidities and demographic factors. METHODS Patients undergoing elective TSA from 2011 to 2016 in the American College of Surgeons National Surgical Quality Improvement Program were queried. A random forest machine learning model was used to predict which patients had a length of stay of 1 day or less (short stay). A multivariable logistic regression was then used to identify which variables were significantly correlated with a short or long stay. RESULTS From 2011 to 2016, 4,500 patients were identified as having undergone elective TSA and having the necessary predictive features and outcomes recorded. The machine learning model was able to successfully identify short stay patients, producing an area under the receiver operator curve of 0.77. The multivariate logistic regression identified numerous variables associated with a short stay including age less than 70 years and male sex as well as variables associated with a longer stay including diabetes, chronic obstructive pulmonary disease, and American Society of Anesthesiologists class greater than 2. CONCLUSIONS Machine learning may be used to predict which patients are suitable candidates for short stay or outpatient TSA based on their medical comorbidities and demographic profile.
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Bixby EC, Boddapati V, Anderson MJJ, Mueller JD, Jobin CM, Levine WN. Trends in total shoulder arthroplasty from 2005 to 2018: lower complications rates and shorter lengths of stay despite patients with more comorbidities. JSES Int 2020; 4:657-661. [PMID: 32939502 PMCID: PMC7479025 DOI: 10.1016/j.jseint.2020.04.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Total shoulder arthroplasty (TSA) is an increasingly common procedure. This study looked at trends in TSA using a nationwide registry, with a focus on patient demographics, comorbidities, and complications. Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent TSA from 2005 to 2018. Cohorts were created based on year of surgery: 2005-2010 (N = 1116), 2011-2014 (N = 5920), and 2015-2018 (N = 16,717). Patient demographics, comorbidities, operative time, hospital length of stay, discharge location, and complications within 30 days of surgery were compared between cohorts using bivariate and multivariate analysis. Results Bivariate analysis revealed significantly more comorbidities among patients in the 2015-2018 cohort compared with the 2005-2010 cohort, specifically American Society of Anesthesiologist class III or IV (57.0% vs. 44.3%, P < .001), morbid obesity (10.8% vs. 7.8%, P < .001), diabetes (17.8% vs. 12.1%, P < .001), and chronic obstructive pulmonary disease (6.7% vs. 4.1%, P = .003). The use of regional anesthesia has decreased (5.6% in 2005-2010 vs. 2.8% in 2015-2018, P < .001), as has operative time (▵: −16 minutes, P < .001) and length of stay (▵: −0.6 days, P < .001). There were also significant decreased rates of perioperative blood transfusion (OR [odds ratio], 0.46), non-home discharge (OR, 0.79), urinary tract infection (OR, 0.47), and sepsis (OR, 0.17), (P < .001 for all comparisons) between the 2005-2010 and 2015-2018 cohorts. Conclusions Between 2005 and 2018, patients undergoing TSA had increasingly more comorbidities but experienced lower rates of short-term complications, in the context of shorter hospitalizations and more frequent discharge to home.
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Affiliation(s)
- Elise C Bixby
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Venkat Boddapati
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Matthew J J Anderson
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - John D Mueller
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Charles M Jobin
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - William N Levine
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
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Orthopaedics and neurosurgery: Is there a difference in surgical outcomes following anterior cervical spinal fusion? J Orthop 2020; 21:278-282. [PMID: 32508432 DOI: 10.1016/j.jor.2020.05.015] [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: 04/22/2020] [Revised: 04/24/2020] [Accepted: 05/15/2020] [Indexed: 11/21/2022] Open
Abstract
Objective The superiority of neurosurgical over orthopaedic spinal procedures is a point of contention. While there is the perception that neurosurgeons are more specifically trained to deal with spinal pathology, no study has directly compared outcomes of spinal surgeries performed by both groups. Methods We sought to evaluate the differences in length of surgery, hospital stay, complications, mortality, and readmission for anterior cervical decompression and fusion (ACDF) performed by neurosurgeons versus orthopaedic surgeons. Results 17,967 ACDF procedures were analyzed. Neurosurgeons performed 74.3% of the fusions with a trend towards longer operative times and significantly more patients that were discharged to extended care facilities. There was no significant difference in the length of stay, overall complications, mortality, readmission, or reoperation when comparing the two specialties. Conclusion Despite a significantly higher volume of ACDF performed by neurosurgeons, outcomes are comparable following orthopaedic and neurosurgical procedures.
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Dacombe P, Harries L, McCann P, Crowther M, Packham I, Sarangi P, Whitehouse MR. Predictors of length of stay following shoulder arthroplasty in a high-volume UK centre. Ann R Coll Surg Engl 2020; 102:493-498. [PMID: 32302224 DOI: 10.1308/rcsann.2020.0052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Shoulder arthroplasty rates are increasing in the UK. No data have been published from a UK centre on predictors of length of inpatient stay following shoulder arthroplasty. This study analyses the length of inpatient stay following shoulder arthroplasty in a high-volume UK centre and identifies predictors of prolonged inpatient stay. MATERIALS AND METHODS All shoulder arthroplasty cases performed between 2012 and 2018 were identified. A review of case notes and electronic patient records was completed to identify demographic data, Charlson comorbidity score, length of inpatient stay and factors associated with length of stay. Multiple linear regression analysis was conducted to determine which factors were independently associated with length of inpatient stay. RESULTS A total of 640 shoulder arthroplasty cases were performed in 566 patients. Median length of stay was two days. Length of stay was predicted by age, sex, chronic kidney disease, congestive cardiac failure, previous myocardial infarction, intraoperative complication and postoperative transfusion. DISCUSSION Increasing age, female sex, chronic kidney disease, congestive cardiac failure, previous myocardial infarction, intraoperative complication and transfusion were independent predictors of increased length of stay. Strategies to reduce perioperative complication and transfusion, and to optimise renal and cardiac comorbidities may reduce overall length of stay for shoulder arthroplasty patients.
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Affiliation(s)
- P Dacombe
- Southmead Hospital, Westbury on Trym, Bristol, UK
| | - L Harries
- Southmead Hospital, Westbury on Trym, Bristol, UK
| | - P McCann
- Southmead Hospital, Westbury on Trym, Bristol, UK.,Bristol Royal Infirmary, Bristol, UK
| | - M Crowther
- Southmead Hospital, Westbury on Trym, Bristol, UK
| | - I Packham
- Southmead Hospital, Westbury on Trym, Bristol, UK
| | - P Sarangi
- Southmead Hospital, Westbury on Trym, Bristol, UK
| | - M R Whitehouse
- Southmead Hospital, Westbury on Trym, Bristol, UK.,University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
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Knapp BM, Botros M, Sing DC, Curry EJ, Eichinger JK, Li X. Sex differences in complications and readmission rates following shoulder arthroplasty in the United States. JSES Int 2020; 4:95-99. [PMID: 32195469 PMCID: PMC7075761 DOI: 10.1016/j.jseint.2019.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Shoulder arthroplasty (SA) procedures are increasingly performed in the United States. However, there is a lack of data evaluating how patient sex may affect perioperative complications. The purpose of this study was to evaluate sex-based differences in 30-day postoperative complication and readmission rates after SA. Methods Total SA and reverse SA cases between 2012-2016 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. The 30-day complication rate, readmission rate, operation time, length of stay, and mortality were compared between women and men. Multivariable logistic regression analysis was performed to identify independent perioperative complications associated with patient sex. Results Of 12,530 SA cases, 6949 (55.4%) were female and 5499 (44.5%) were male. Compared with women, on average men were significantly younger, had lower body mass index, and were less likely to be functionally dependent, and less likely to have an American Society of Anesthesiologists score of 3+ (P < .001). Although overall complications and readmission rates between women and men were similar (3.4% vs. 3.7%, P = .489; 3.0% vs. 2.8%, P = .497), men were significantly less likely to develop urinary tract infections (UTIs; odds ratio [OR] 0.58, P = .032) and require transfusions (OR 0.49, P < .001) and had shorter lengths of stay (P < .001). However, men were significantly more likely to have a superficial surgical site infection (OR 2.63, P = .035) and 6.8 minute longer operating time (P < .001) compared with women. Conclusion Though the overall complication risk is similar between the sexes, their risk profiles are distinct. Men had decreased risk of UTI, blood transfusions, and shorter length of stay but increased risk of surgical site and longer operating time compared with women. This disparity should be discussed when counseling and risk-stratifying patients for SA.
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Affiliation(s)
- Brock M Knapp
- Boston University School of Medicine, Boston, MA, USA
| | | | - David C Sing
- Boston University School of Medicine, Boston, MA, USA.,Boston Medical Center, Boston, MA, USA
| | - Emily J Curry
- Boston Medical Center, Boston, MA, USA.,Boston University School of Public Health, Boston, MA, USA
| | | | - Xinning Li
- Boston University School of Medicine, Boston, MA, USA.,Boston Medical Center, Boston, MA, USA
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Ode GE, Odum S, Connor PM, Hamid N. Ambulatory versus inpatient shoulder arthroplasty: a population-based analysis of trends, outcomes, and charges. JSES Int 2020; 4:127-132. [PMID: 32195474 PMCID: PMC7075753 DOI: 10.1016/j.jses.2019.10.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background The purpose of this study was to evaluate the clinical outcomes and cost of shoulder arthroplasty (SA) performed in ambulatory surgery centers (ASCs) compared with SA performed in hospital-based surgery settings. Methods The State Inpatient Databases and the State Ambulatory Surgery Databases were queried for patients undergoing primary or reverse SA between 2010 and 2014 in 5 states in either the inpatient (IP), hospital outpatient department (HOPD), or ASC setting. Outcomes included all-cause readmissions, emergency department visits within the 90-day postoperative period, and charges. Covariates included patient demographic data and procedure details. Risk factors for readmission were calculated using logistic regression analysis. Results We identified 795 ASC (2%), 183 HOPD (0.5%), 38,114 (97.5%) SA procedures. The outpatient cohort was overall younger and healthier with a lower percentage of diabetes (14.1% vs. 20.2%), cardiopulmonary disease (11.4% vs. 20.4%), and obesity (10.7% vs. 15.6%). The US state and obesity were factors significantly (P < .0001) associated with readmission. The median IP charge was $62,905 (range, $41,327-$87,881) vs. $37,395 (range, $21,976-$61,775) for combined outpatient cases. When outpatient SA was stratified into ASC and HOPD cases, the median charges were $31,790 for ASC cases vs. $55,990 for HOPD cases (P < .0001). After adjustment for multiple covariates, the charges for combined outpatient SA surgery were 40% lower than those for IP SA surgery (P < .0001). Conclusion As the current health care climate shifts toward lower-cost and higher-quality care, this study demonstrates that SAs performed in ASCs have a comparable safety profile to and significant financial advantage over SAs performed in the hospital-based setting.
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Affiliation(s)
- Gabriella E Ode
- Department of Orthopaedic Surgery, Prisma Health - Upstate, Greenville, SC, USA
| | - Susan Odum
- Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | | | - Nady Hamid
- OrthoCarolina Sports Medicine Center, Charlotte, NC, USA
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Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) focuses on optimizing each element on a treatment pathway and encouraging the patient to actively engage in his or her recovery and rehabilitation. It requires collaboration across a multidisciplinary team and has been successful in improving patient outcomes, length of stay (LOS), and costs for a wide range of surgical procedures, including musculoskeletal surgeries such as total hip and total knee replacement. PURPOSE To examine the application of ERAS concepts to total shoulder replacement (TSR) surgery. METHODS Hospital Episode Statistics (HES) in England on LOS for TSR surgery were examined, and a review of literature on the use of ERAS concepts in TSR was undertaken. RESULTS Analysis of HES data suggested scope for improvement in reducing LOS. A review of the literature found some evidence of the use of ERAS concepts, particularly in multimodal pain management. CONCLUSIONS Future research is now required for ERAS procedure-specific components for TSR surgery.
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Non-medical factors significantly influence the length of hospital stay after surgery for degenerative spine disorders. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:203-212. [PMID: 31734806 DOI: 10.1007/s00586-019-06209-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Unnecessarily long hospital stays are costly and inefficient. Studies have shown that the length of hospital stay (LOS) for spine surgical procedures is influenced by various disease-related or medical factors, but few have examined the role of socio-demographic/socio-economic (SDE) factors. METHODS This was a retrospective analysis of data from 10,770 patients (5056 men, 5714 women; 62 ± 15 years) with degenerative spinal disorders, collected prospectively in an in-house database within the framework of EUROSPINE's Spine Tango Registry. Surgeons completed the Tango surgery form (clinical history, demographics, surgical measures, complications), and patients, a baseline Core Outcome Measures Index. Stepwise linear regression analyses examined SDE predictors of LOS, controlling for potential medical/biological factors. RESULTS The mean LOS was 7.9 ± 5.2 days. The final model accounted for 42% of variance in LOS, with SDE variables explaining 13% variance and medical/surgical predictors, 29%. In the final model, the SDE factors age and being female were significant independent predictors of LOS, whereas others were either non-significant (insurance status, being of Swiss nationality, being a smoker) or reached only borderline significance (p < 0.1) (BMI). Controlling for all other SDE and medical/surgical confounders, being female was associated with 1.11-day longer LOS (95% CI 0.96-1.27; p < 0.0001). CONCLUSIONS Patients of advanced age and female gender are at increased risk of longer hospital stay after surgery for degenerative spinal disorders. Further studies should seek to understand the reasoning behind the gender disparity, in order to minimise potentially unnecessary costs of prolonged LOS. Targeted preoperative discharge planning may improve the utilisation of hospital resources. These slides can be retrieved under Electronic Supplementary Material.
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Inpatient Pain Scores and Narcotic Utilization Based on American Society of Anesthesiologists Score Following Anterior Cervical Discectomy and Fusion. Spine (Phila Pa 1976) 2019; 44:1558-1563. [PMID: 31689250 DOI: 10.1097/brs.0000000000003135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective. OBJECTIVE To examine the relationship between American Society of Anesthesiologists (ASA) score and inpatient pain and narcotics consumption following anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA Higher ASA scores have been previously linked to increased postoperative complication rates, healthcare costs, length of stay, and hospital readmissions. However, to our knowledge, there have not been previous investigations into the association between ASA scores and postoperative inpatient pain and narcotics utilization following ACDF. METHODS Patients who underwent a single-level, primary ACDF were retrospectively reviewed and stratified into two cohorts based on ASA score less than or equal to 2 or ASA score more than 2. ASA score was tested for association with demographic variables and perioperative characteristics using student's t test, chi-squared analysis, and Fisher exact test. Inpatient pain scores and narcotics consumption on each postoperative day were then compared between cohorts using bivariate linear regression. RESULTS Two hundred eleven patients who underwent ACDF were included: 184 had an ASA score less than or equal to 2 and 27 had an ASA score more than 2. Higher ASA score was associated with older age, higher comorbidity burden as measured by the modified Charlson Comorbidity Index (CCI), and lower prevalence of obesity. Higher ASA scores were associated with longer duration of hospital stay, while other perioperative characteristics were similar between ASA score cohorts. There were no differences in inpatient Visual Analog Scale (VAS) pain scores, or hourly, daily, and cumulative inpatient narcotic consumption between cohorts on any postoperative day. CONCLUSION This retrospective investigation demonstrated that a higher ASA score is associated with increased operative time following ACDF. However, ASA score was determined not to be an independent risk factor that can predict postoperative pain or narcotics consumption among patients who undergo ACDF. Therefore, postoperative pain in the inpatient setting can be managed with similar modalities regardless of ASA score for patients undergoing ACDF. LEVEL OF EVIDENCE 3.
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Total shoulder arthroplasty: risk factors for a prolonged length of stay. A retrospective cohort study. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Luthringer TA, Kester BS, Kolade O, Virk MS, Alaia MJ, Campbell KA. Shoulder Arthroplasty for Posttraumatic Arthritis Is Associated With Increased Transfusions and Longer Operative Times. J Shoulder Elb Arthroplast 2019. [DOI: 10.1177/2471549219882133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Posttraumatic arthritis (PTA) is a common sequela of proximal humerus fractures that is commonly managed with anatomic or reverse total shoulder arthroplasty (TSA). TSA for PTA is more challenging than that performed for primary osteoarthritis and frequently leads to worse patient outcomes. CPT uniformly classifies all cases of primary TSA, irrespective of procedural complexity and resource utilization. This study analyzes intraoperative differences and 30-day outcomes for anatomic and reverse TSA performed in the posttraumatic shoulder. Methods: Patients undergoing TSA from 2008 to 2015 were selected from the National Surgical Quality Improvement Program database and stratified according to concurrent procedures and administrative codes indicating posttraumatic diagnoses. Perioperative parameters and 30-day complications were recorded; multivariate analyses were performed to determine whether PTA was a risk factor for poor outcomes. Results: A total of 8508 primary and 243 posttraumatic TSAs were identified. Posttraumatic TSA patients were slightly younger ( P = .003), more likely to be female ( P < .001), smokers ( P = .029), and diabetic ( P = .003). Diagnosis of PTA was an independent risk factor for prolonged operative times ≥160 minutes (≥1 standard deviation above the mean, P = .003; odds ratio [OR]: 1.718; 95% confidence interval [CI]: 1.204–2.449) and increased bleeding requiring transfusion ( P < .001; OR: 2.719; 95% CI: 1.607–4.600). Although posttraumatic TSA had a tendency for longer hospital admissions, 30-day readmissions were not significantly different between cohorts. Conclusions: Compared with primary osteoarthritis, a preoperative diagnosis of PTA is an independent risk factor for prolonged operative times and postoperative transfusion in anatomic or reverse TSA patients; such patients may be less than optimal candidates for same-day discharges or outpatient shoulder arthroplasty.
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Affiliation(s)
- Tyler A Luthringer
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York
| | - Benjamin S Kester
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York
| | - Oluwadamilola Kolade
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York
| | - Mandeep S Virk
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York
| | - Michael J Alaia
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York
| | - Kirk A Campbell
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York
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Abstract
Background There is growing policy interest in reducing the length of stay (LOS) after discretionary orthopedic surgery but few data to guide improvement efforts. We characterized the primary reasons and predisposing factors associated with extended LOS after elective total shoulder arthroplasty. Methods We retrospectively identified 415 patients undergoing elective primary total shoulder arthroplasty between 2016 and 2017. Extended LOS was defined as a stay greater than the 75th percentile. Medical records were manually reviewed to ascertain the primary reason for extended LOS. Multivariable logistic regression modeling was used to determine preoperative characteristics associated with prolonged hospitalization. Results The most common reason for extended LOS was pain (41%), followed by medical problems (39%), limited social support (18%), and blood transfusions (2%). Only 41% of patients with delayed discharges had documented adverse events (any medical or surgical problem), all of which were minor. The top 4 medical issues were transient hypoxemia (42%), nausea and/or vomiting (13%), electrolyte abnormalities (12%), and altered mental status (10%). In decreasing order of magnitude, the predictors of prolonged LOS were greater number of self-reported allergies, female sex, unmarried patient, diabetes, lower American Shoulder and Elbow Surgeons score, depression, reverse shoulder arthroplasty, and American Society of Anesthesiologists score of 3 or greater. Operative time did not correlate with LOS. Conclusions Prolonged hospitalizations after shoulder arthroplasty are commonly related to pain and limited social support. Sociodemographic and psychological factors seem to have more influence than patient infirmity and technical issues. These findings support a comprehensive approach to care with attention to the physical, mental, and social determinants of health.
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Predictors of Length of Stay and Discharge Disposition After Shoulder Arthroplasty: A Systematic Review. J Am Acad Orthop Surg 2019; 27:e696-e701. [PMID: 30499894 DOI: 10.5435/jaaos-d-18-00244] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Identifying patient factors that affect length of stay (LOS) and discharge disposition after shoulder arthroplasty is key in managing patient expectations. In this systematic review, we identify patient-specific covariates that correlate with increased LOS and need for discharge to a facility. METHODS We searched biomedical databases to identify associations between patient-specific factors and LOS and discharge disposition after shoulder arthroplasty. We included all studies involving hemiarthroplasty, anatomic shoulder arthroplasty, and reverse shoulder arthroplasty. Reported patient and provider factors were evaluated for their association with increased LOS and discharge to a facility. RESULTS Twenty-two studies were identified. Age >65 years, female sex, obesity, and reverse shoulder arthroplasty were associated with extended LOS and correlated with discharge to a facility. Greater hospital and surgeon volume were associated with decreased LOS and decreased risk of discharge to a facility. Local injection of liposomal bupivacaine combined with intravenous dexamethasone was associated with reduced LOS. DISCUSSION Patient factors affecting LOS and likelihood of discharge to a facility include age >65 years, female sex, diabetes, obesity, and reverse shoulder arthroplasty. These factors can be used to develop studies to preoperatively predict outcomes after shoulder arthroplasty and to help identify patients who may be at risk of prolonged postoperative admission. LEVEL OF EVIDENCE Prognostic level IV.
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Okoroha KR, Muh S, Gabbard M, Evans T, Roche C, Flurin PH, Wright TW, Zuckerman JD. Early outcomes of shoulder arthroplasty according to sex. JSES OPEN ACCESS 2019; 3:43-47. [PMID: 30976735 PMCID: PMC6443835 DOI: 10.1016/j.jses.2018.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hypothesis Among patients undergoing shoulder arthroplasty (SA), female patients would have worse outcomes than their male counterparts. Methods A multicenter prospective cohort of 2364 patients (1365 female and 999 male patients) treated with total SA or reverse total SA from 2007 to 2015 was retrospectively analyzed. Results were assessed using several validated outcome measures and range-of-motion testing. A multivariable analysis identified differences in preoperative values, postoperative values, and preoperative-to-postoperative improvements while adjusting for possible confounders. Results The mean follow-up period was 45.9 ± 23.7 months in female patients and 46.4 ± 23.6 months in male patients. Women underwent SA at a significantly older age (70.8 ± 8.4 years) than men (67.6 ± 8.8 years, P < .01) and began with lower preoperative outcome scores and range-of-motion measurements: American Shoulder and Elbow Surgeons score (P < .01), Constant score (P < .01), Simple Shoulder Test score (P < .01), active abduction (P < .01), forward flexion (P < .01), and external rotation (P = .02). Postoperatively, both groups showed significant improvement. When we evaluated overall improvement from preoperative values, female patients showed increased improvements in the American Shoulder and Elbow Surgeons score (P = .04) and Simple Shoulder Test score (P < .01), as well as active forward elevation (P < .01) and external rotation (P = .02). However, the difference in improvements did not reach the minimal clinically important difference. Women had a higher incidence of component loosening (P = .03) and periprosthetic fractures due to falls (P = .01), whereas men showed a higher incidence of periprosthetic joint infections (P < .01). Conclusion This study found that female patients undergo SA at an older age and begin with worse shoulder range of motion and outcome scores than male patients. Although women experienced a greater improvement postoperatively in outcome scores and range of motion, this improvement did not reach the minimal clinically important difference. These findings suggest that male and female patients can expect similar improvements in function after undergoing SA; however, the incidence of complications may vary depending on sex.
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Affiliation(s)
- Kelechi R Okoroha
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Stephanie Muh
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Michael Gabbard
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Timothy Evans
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA
| | | | | | - Thomas W Wright
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Joseph D Zuckerman
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA
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Yin C, Sing DC, Curry EJ, Abdul-Rassoul H, Galvin JW, Eichinger JK, Li X. The Effect of Race on Early Perioperative Outcomes After Shoulder Arthroplasty: A Propensity Score Matched Analysis. Orthopedics 2019; 42:95-102. [PMID: 30810757 DOI: 10.3928/01477447-20190221-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 02/04/2019] [Indexed: 02/03/2023]
Abstract
There is a paucity of data on how racial disparities may affect early outcomes following shoulder arthroplasty. The purpose of this study was to evaluate differences in 30-day complications and readmission rates after shoulder arthroplasty based on race. White and black patients who underwent hemiarthroplasty, anatomic or reverse total shoulder arthroplasty (Current Procedural Terminology codes 23470 and 23472) between 2006 and 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Black patients were propensity score matched 1:4 based on preoperative demographics and comorbidities to white patients. Multivariable analysis was performed to assess postoperative complications based on race. Of the 12,663 patients with shoulder arthroplasty identified, 10,717 (84.6%) were white and 559 (4.4%) were black. Overall, 557 black patients were matched to 2228 white patients, for a total cohort of 2785 patients (mean age, 63.9±11.7 years; female, 61.0%). Surgical indications were similar between black and white patients. The 2 races had similar rates of overall complications, major complications, minor complications, readmissions, and discharge to facility. Mortality was significantly higher among black patients compared with white patients (0.6% vs 0.05%; P=.033). Black patients also experienced longer operative time (mean, 126.4 vs 112.5 minutes; P<.001) and length of stay (mean, 2.4 vs 2.1 days; P<.001). There was a significant disparity with underutilization of shoulder arthroplasty for black patients in the American College of Surgeons National Surgical Quality Improvement Program database. Black and white patients undergoing shoulder arthroplasty experienced similar rates of 30-day complications, readmissions, and discharge to facility. However, black patients experienced greater operative time, total length of stay, and mortality compared with white patients. [Orthopedics. 2019; 42(2):95-102.].
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Orive M, Aguirre U, Gonzalez N, Lázaro S, Redondo M, Bare M, Anula R, Briones E, Escobar A, Sarasqueta C, Garcia-Gutierrez S, Quintana JM. Risk factors affecting hospital stay among patients undergoing colon cancer surgery: a prospective cohort study. Support Care Cancer 2019; 27:4133-4144. [PMID: 30793242 DOI: 10.1007/s00520-019-04683-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/26/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE To identify and validate risk factors that contribute to prolonged length of hospital stay (LOS) in patients undergoing resection for colorectal cancer. METHODS This prospective cohort study included 1955 patients admitted to 22 hospitals for primary resection of colorectal cancer. Multivariate analyses were used to identify and validate risk factors, randomizing patients into a derivation and a validation cohort. Multiple correspondence and cluster analysis were performed to identify clinical subtypes based on LOS. RESULTS The strongest independent predictors of prolonged LOS were postoperative reintervention, surgical site infection, open surgery, and distant metastasis. The multiple correspondence and cluster analysis provided three groups of patients in relation to prolonged LOS: patients with the longest LOS included the highest percentage of patients with open surgery, distant metastasis, deep surgical site infections, emergency admissions, additional diagnostic factors, and highly contaminated surgical sites. Patients with prolonged LOS (> 14 days) were more likely to develop adverse outcomes within 30 days after discharge. CONCLUSIONS Patients undergoing resection of colorectal cancer cluster into different groups based on LOS of the index admission. Those with prolonged LOS were more likely to develop adverse outcomes within 30 days after discharge. Some of the strongest independent predictors of prolonged LOS, such as surgical infections or open surgery, could be modified to reduce LOS and, in turn, other adverse outcomes. TRIAL REGISTRATION NCT02488161.
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Affiliation(s)
- Miren Orive
- Research Unit, Hospital Galdakao-Usansolo, B° Labeaga s/n, 48960, Galdakao, Biscay, Spain.
- Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain.
| | - Urko Aguirre
- Research Unit, Hospital Galdakao-Usansolo, B° Labeaga s/n, 48960, Galdakao, Biscay, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain
| | - Nerea Gonzalez
- Research Unit, Hospital Galdakao-Usansolo, B° Labeaga s/n, 48960, Galdakao, Biscay, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain
| | - Santiago Lázaro
- General Surgery Service, Galdakao-Usansolo Hospital, Galdakao, Bizkaia, Spain
| | - Maximino Redondo
- Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain
- Research Unit, Hospital Costa del Sol, Málaga, Spain
| | - Marisa Bare
- Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain
- Clinical Epidemiology Unit, Corporacio Parc Tauli, Barcelona, Spain
| | - Rocío Anula
- Colorectal Unit, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Antonio Escobar
- Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain
- Research Unit, Basurto University Hospital, Basurto, Bilbao, Bizkaia, Spain
| | - Cristina Sarasqueta
- Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain
- Research Unit, Donostia University Hospital, Donostia-San Sebastian, Gipuzkoa, Spain
| | - Susana Garcia-Gutierrez
- Research Unit, Hospital Galdakao-Usansolo, B° Labeaga s/n, 48960, Galdakao, Biscay, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain
| | - José M Quintana
- Research Unit, Hospital Galdakao-Usansolo, B° Labeaga s/n, 48960, Galdakao, Biscay, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain
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Outpatient Shoulder Arthroplasty at an Ambulatory Surgery Center Using a Multimodal Pain Management Approach. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2018; 2:e064. [PMID: 30656252 PMCID: PMC6324887 DOI: 10.5435/jaaosglobal-d-18-00064] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Introduction: Early reports of outpatient shoulder arthroplasty are promising, although a paucity of outcome data exists, particularly for the outpatient shoulder arthroplasty performed at a freestanding ambulatory surgery center (ASC). Methods: A retrospective analysis of 61 shoulder arthroplasty procedures (21 consecutive outpatients and 40 inpatients) was performed. Outpatient shoulder arthroplasties were conducted at a freestanding ASC using a multimodal pain regimen without the use of regional anesthesia. The primary outcome was 90-day postoperative complication rate. Secondary outcomes included 90-day hospital admissions or readmissions, emergency department and urgent care visits, revision surgeries, mortality, postoperative pain, and functional scores. Results: No major complications, readmissions, revision surgeries, or deaths occurred in the outpatient cohort. The rate of 90-day complications was 9.5% and 17.5% for the outpatient and inpatient cohorts, respectively. All patients who had their shoulder arthroplasty as an outpatient were discharged home the day of surgery. No complications related to the outpatient protocol were observed. However, 4.8% of those who had outpatient surgery visited an emergency department or urgent care within 90 days compared with 5.0% of those who had surgery as an inpatient. Discussion: Outpatient shoulder arthroplasty can be performed safely and predictably in select patients at an ASC using a multimodal pain regimen without regional nerve block.
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Brolin TJ, Thakar OV, Abboud JA. Outcomes After Shoulder Replacement Surgery in the Young Patient. Clin Sports Med 2018; 37:593-607. [DOI: 10.1016/j.csm.2018.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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