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Jenny JY, Godier A, Heim C, Langenecker S, Thienpont E, Eikelboom J. European guidelines on peri-operative venous thromboembolism prophylaxis: first update.: Chapter 13: Nonambulatory orthopaedic surgery. Eur J Anaesthesiol 2024; 41:622-626. [PMID: 38957031 DOI: 10.1097/eja.0000000000002020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Affiliation(s)
- Jean-Yves Jenny
- From the ELSAN Clinique Sainte Odile, Haguenau, France; ESH (J-YJ), Service d'anesthésie réanimation, Hôpital Européen Georges Pompidou; INSERM UMRS-1140; Université Paris Cité, ESAIC (AG), CHUV - University Hospital Lausanne, Switzerland; Department of Anesthesiology, ESAIC (CH), Department of Anaesthesia and Intensive Care, Evangelical Hospital Vienna and Sigmund Freud Private University, Vienna, Austria; ESAIC (SL), Cliniques universitaires Saint Luc, Bruxelles, Belgique, EKS (ET), and McMaster University, Hamilton, Canada (JE)
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Edwards MA, Falstin M, Uddandam A, Brennan E, Spaulding A. Caprini guideline indicated venous thromboembolism (VTE) prophylaxis among inpatient surgical patients: are there racial/ethnic differences in practice patterns and outcomes? Am J Surg 2024:115785. [PMID: 38849278 DOI: 10.1016/j.amjsurg.2024.115785] [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: 12/17/2023] [Revised: 03/04/2024] [Accepted: 05/27/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND While racial disparity in surgical mortality due to venous thromboembolism (VTE) has improved, a gap persists. Our study aim was to determine differences in VTE prevention practices and their impact on outcomes among racial surgical cohorts. METHODS Elective surgeries performed between 1.1.2016 and 5.31.2021 were included. Racial/ethnic cohorts were propensity-matched 1:1 to non-Hispanic White (NHW) patients, and outcomes were compared using unadjusted logistic regression. Match cohort balance was assessed using absolute standardized mean differences and linear model analysis of variance (ANOVA). Pearson's Chi-square tests evaluated bi-variate associations. Conditional logistic regression to compare outcomes between matched groups. Odds ratios, 95 % confidence intervals, and p-values are reported. Analyses were performed using R version 4.1.2 and the R package Matchit. RESULTS Non-Hispanic other race (NHOR) (vs. NHW) patients were less likely to receive inpatient prophylaxis (OR 0.86, CI:0.76-0.98). Appropriate prophylaxis resulted in similar VTE for NHB (p = 0.71) and Hispanic (p = 0.06), compared to NHW patients. Inpatient bleeding was higher in Hispanic patients with a higher likelihood of receiving appropriate prophylaxis (OR 1.94, CI:1.16-3.32) and NHOR patients with a lower likelihood (OR 1.90, CI:1.10-3.36) CONCLUSION: Postoperative VTE was similar for minority patients receiving appropriate prophylaxis, compared to NHW patients. Inpatient bleeding was more likely in Hispanic and NHOR patients but may not be related to receiving appropriate prophylaxis. NHOR patients were less likely to receive inpatient thromboprophylaxis.
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Affiliation(s)
- Michael A Edwards
- Mayo Clinic, Department of Surgery, Division of Advanced GI and Bariatric Surgery, Jacksonville, FL, 32224, USA.
| | - Mark Falstin
- Mayo Clinic, Department of Surgery, Division of Advanced GI and Bariatric Surgery, Jacksonville, FL, 32224, USA
| | - Akash Uddandam
- McMaster University, Department of Health Sciences, Hamilton, Ontario, L8S 4L8, Canada
| | - Emily Brennan
- Mayo Clinic, Robert D. and Patricia E. Kern Center, Division of Health Care Delivery Research, Jacksonville, FL, 32224, USA
| | - Aaron Spaulding
- Mayo Clinic, Robert D. and Patricia E. Kern Center, Division of Health Care Delivery Research, Jacksonville, FL, 32224, USA
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Zehner KM, Sanchez JG, Dhodapkar MM, Modrak M, Luo X, Grauer JN. Total shoulder arthroplasty in patients with factor V Leiden. J Shoulder Elbow Surg 2024:S1058-2746(24)00160-5. [PMID: 38479723 DOI: 10.1016/j.jse.2024.01.041] [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: 11/14/2023] [Accepted: 01/24/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Anatomic and reverse total shoulder arthroplasty (TSA) are effective treatment options for end-stage glenohumeral osteoarthritis. However, consideration for pre-existing conditions must be taken into account. Factor V Leiden (FVL), the most common inherited thrombophilia, is one such condition that predisposes to a prothrombotic state and may affect perioperative and longer-term outcomes following TSA. METHODS Adult patients undergoing primary TSA for osteoarthritis indication were identified in the 2010 through October 2021 PearlDiver M157 database. Patients with or without FVL were matched at a 1:4 ratio based on age, sex, and Elixhauser Comorbidity Index. Ninety-day adverse events and 5-year revision rates were assessed and compared with multivariable logistic regression and rank-log tests, respectively. Finally, the relative use and bleeding/clotting outcomes were assessed based on venous thromboembolic (VTE) prophylactic agents used, with categories defined as (1) warfarin, heparin, or direct oral anticoagulant (DOAC) or (2) aspirin/no prescription found. RESULTS Of 104,258 TSA patients, FVL was identified for 283 (0.27%). Based on matching, 1081 patients without FVL and 272 patients with FVL were selected. Multivariable analyses demonstrated that those with FVL displayed independently greater odds ratios (ORs) of deep vein thrombosis (DVT, OR = 9.50, P < .0001), pulmonary embolism (PE, OR = 10.10, P < .0001), and pneumonia (OR = 2.43, P = .0019). Further, these events contributed to the increased odds of aggregated minor (OR = 1.95, P = .0001), serious (OR = 6.38, P < .0001), and all (OR = 3.51, P < .0001) adverse events. All other individual 90-day adverse events, as well as 5-year revision rates, were not different between the study groups. When compared to matched patients without FVL on the same anticoagulant agents, FVL patients on warfarin, heparin, or DOAC agents demonstrated lesser odds of 90-day DVT and PE (OR = 4.25, P < .0001, and OR = 2.54, P = .0065) than those on aspirin/no prescription found (OR = 7.64 and OR = 21.95, P < .0001 for both). Interestingly, those on VTE prophylactic agents were not at greater odds of bleeding complications (hematoma or transfusion). DISCUSSION AND CONCLUSIONS TSA patients with FVL present a difficult challenge to shoulder reconstruction surgeons. The current study highlights the strong risk of VTE that was reduced but still significantly elevated for those with stronger classes of VTE chemoprophylaxis. Acknowledging this risk is important for surgical planning and patient counseling, but also noted was the reassurance of similar 5-year revision rates for those with vs. without FVL.
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Affiliation(s)
- Katie M Zehner
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Joshua G Sanchez
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Meera M Dhodapkar
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Maxwell Modrak
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Xuan Luo
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA.
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Momenzadeh K, Yeritsyan D, Mortensen S, Kheir N, Khak M, Caro D, Kahe F, Abbasian M, Mo C, McNichol M, Paschos N, Nazarian A. While the Incidence of Venous Thromboembolism After Shoulder Arthroscopy Is Low, the Risk Factors Are a Body Mass Index Greater than 30 and Hypertension. Arthrosc Sports Med Rehabil 2024; 6:100815. [PMID: 38149088 PMCID: PMC10749995 DOI: 10.1016/j.asmr.2023.100815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/20/2023] [Indexed: 12/28/2023] Open
Abstract
Purpose This study aims to determine the overall incidence of venous thromboembolism (VTE) following shoulder arthroscopy and to define potential risk factors associated with its development that may help define guidelines for the use of thromboprophylaxis. Methods A systematic review was performed using PubMed, Embase, Web of Science, CINAHL, and Cochrane databases per PRISMA guidelines. The search terms consisted of variations of "Venous Thromboembolism" and "Shoulder Arthroscopy." Information regarding arthroscopy indication, risk factors, outcomes, and patient demographics was recorded and analyzed, and pooled odds ratios were reported for each variable. Results Six hundred eighty-five articles were identified in the initial search, and 35 articles reported DVT, PE, or VTE incidence following shoulder arthroscopy. Seventeen nonoverlapping articles with a unique patient population incidence rates. Four articles were then used for subgroup meta-analysis. The incidence rate of VTE was 0.24%, ranging from 0.01% to 5.7%. BMI >30 (OR = 1.46; 95% CI = [1.22, 1.74]; I2 = 0%) and hypertension (OR = 1.64; 95% CI = [1.03, 2.6]; I2 = 75%) were significant risk factors (P < .05) for developing VTE following shoulder arthroscopy. Diabetes (OR = 1.2; 95% CI = [0.97, 1.48]; I2 = 0%), insulin-dependent diabetes (OR = 5.58; 95% CI = [0.12, 260.19]; I2 = 85%), smoking (OR = 1.04; 95% CI = [0.79, 1.37]; I2 = 12%), male sex (OR = 0.95; 95% CI = [0.49, 1.85]; I2 = 86%) and age over 65 (OR = 4.3; 95% CI = [0.25, 72.83]; I2 = 85%) were not associated with higher VTE risk. Conclusion The VTE incidence following shoulder arthroscopy is low at 0.24%. Patients with BMI >30 and hypertension are at a higher risk for VTE after shoulder arthroscopy. Level of Evidence Level IV, systematic review and meta-analysis of Level I-IV studies.
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Affiliation(s)
- Kaveh Momenzadeh
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Diana Yeritsyan
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Sharri Mortensen
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Nadim Kheir
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Mohammad Khak
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Daniela Caro
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Farima Kahe
- Cardiovascular Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Mohammadreza Abbasian
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Chen Mo
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Megan McNichol
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Nikolaos Paschos
- Orthopaedic Surgery Department, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia
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Kim M, Ling K, Tantone RP, Al-Humadi S, Wang K, VanHelmond TA, Komatsu DE, Wang ED. Investigating immediate postoperative medical complication risks relative to in-hospital length of stay after total shoulder arthroplasty. JSES Int 2023; 7:2467-2472. [PMID: 37969519 PMCID: PMC10638588 DOI: 10.1016/j.jseint.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background The purpose of this study was to investigate the association between in-hospital length of stay (LOS) and postoperative complication rates within 30 days of total shoulder arthroplasty (TSA). Methods All patients who underwent either anatomic or reverse TSA between 2015 and 2019 were queried from the American College of Surgeons National Surgical Quality Improvement database. The study population was stratified into three cohorts as follows: LOS 0 (same-day discharge), LOS 1 (next-day discharge), and LOS 2-3 (LOS of 2-3 days). Patient demographics and comorbidities were compared between cohorts using bivariate analysis. Multivariate logistic regression analysis was conducted to investigate the relationship between LOS and postoperative complications. Results In comparison to the LOS 0 day cohort, LOS 2-3 day cohort had a greater likelihood of developing overall complication (OR, 2.598; P < .001), major complication (OR, 1.885; P < .001), minor complication (OR: 3.939; P < .001), respiratory complication (OR: 12.979; P = .011), postoperative anemia requiring transfusion (OR, 23.338; P < .001), non-home discharge (OR, 10.430; P < .001), and hospital readmission (OR, 1.700; P = .012). Similarly, in comparison to the LOS 1 cohort, LOS 2-3 cohort had a greater likelihood of developing overall complication (OR: 2.111; P < .001), major complication (OR, 1.423; P < .001), minor complication (OR, 3.626; P < .001), respiratory complication (OR, 2.057; P < .001), sepsis or septic shock (OR: 2.795; P = .008), urinary tract infection (OR, 1.524; P = .031), postoperative anemia requiring transfusion (OR, 10.792; P < .001), non-home discharge (OR: 10.179; P < .001), hospital readmission (OR, 1.395; P < .001), and return to the operating room (OR. 1.394; P = .014). There was no significant difference in the risk of developing postoperative complications between LOS 0 day and LOS 1 day cohort. On baseline, the LOS 1 and LOS 2-3 day cohort had a higher proportion of patients with the following demographics and comorbidities compared to LOS 0 day cohort: advanced age, higher body mass index, female gender, positive smoking status, insulin-dependent diabetes, noninsulin-dependent diabetes, dyspnea at rest and moderate exertion, partially dependent functional status, an American Society of Anesthesiologists classification of 3 or higher, a history of severe chronic obstructive pulmonary disease, a history of congestive heart failure, the use of hypertension medication, disseminated cancer, wound infection, the use of steroids, and a history of bleeding disorder. Conclusion Patients who were discharged on the same and next day following TSA demonstrated a reduced probability of experiencing respiratory complications, infections, postoperative anemia requiring transfusion, non-home discharge, and readmission in comparison to those with a LOS of 2-3 days. There was no difference in postoperative complications between same and nextday discharged patients. Patients who underwent outpatient arthroplasty were healthier at baseline compared to those who underwent inpatient arthroplasty.
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Affiliation(s)
- Matthew Kim
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Kenny Ling
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - Ryan P. Tantone
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - Samer Al-Humadi
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - Katherine Wang
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Taylor A. VanHelmond
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - David E. Komatsu
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - Edward D. Wang
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
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Guo H, Wang T, Li C, Yu J, Zhu R, Wang M, Zhu Y, Wang J. Development and validation of a nomogram for predicting the risk of immediate postoperative deep vein thrombosis after open wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2023; 31:4724-4734. [PMID: 37378681 DOI: 10.1007/s00167-023-07488-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE This study aimed to identify independent risk factors for immediate postoperative deep vein thrombosis (DVT) in patients with open wedge high tibial osteotomy (OWHTO) and to develop and validate a predictive nomogram. METHODS Patients who underwent OWHTO for knee osteoarthritis (KOA) from June 2017 to December 2021 were retrospectively analyzed. Baseline data and laboratory test results were collected, and the occurrence of DVT in the immediate postoperative period was regarded as the study outcome event. Multivariable logistic regression identified independent risk factors associated with a higher incidence of immediate postoperative DVT. The predictive nomogram was constructed based on the analysis results. The stability of the model was further assessed in this study using patients from January to September 2022 as an external validation set. RESULTS 741 patients were enrolled in the study, of which 547 were used in the training cohort and the other 194 for the validation cohort. Multivariate analysis revealed a higher Kellgren-Lawrence (K-L) grade (III vs. I-II OR 3.09, 95% CI 0.93-10.23. IV vs. I-II OR 5.23, 95% CI 1.27-21.48.), platelet to hemoglobin ratio (PHR) > 2.25 (OR 6.10, 95% CI 2.43-15.33), Low levels of albumin (ALB) (OR 0.79, 95% CI 0.70-0.90), LDL-C > 3.40 (OR 3.06, 95% CI 1.22-7.65), D-dimer > 1.26 (OR 2.83, 95% CI 1.16-6.87) and BMI ≥ 28 (OR 2.57, 95% CI 1.02-6.50) were the independent risk factors of immediate postoperative DVT. The concordance index (C-index) and Brier score of the nomogram were 0.832 and 0.036 in the training set, and the corrected values after internal validation were 0.795 and 0.038, respectively. The receiver-operating characteristic (ROC) curve, the calibration curve, the Hosmer-Lemeshow test, and the decision curve analysis (DCA) performed well in both the training and validation cohorts. CONCLUSION This study developed a personalized predictive nomogram with six predictors, which allows surgeons to stratify risk and recommended immediate ultrasound scans for patients with any of these factors. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Haichuan Guo
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Tianyu Wang
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Chengsi Li
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Jiahao Yu
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Ruoxuan Zhu
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Maolin Wang
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yanbin Zhu
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
- Orthopedic Research Institute of Hebei Province, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
| | - Juan Wang
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
- Orthopedic Research Institute of Hebei Province, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
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Marigi EM, Sperling JW, De Marinis R, Gupta P, Hassett LC, Soza F, Sanchez-Sotelo J. Venous thromboembolism following surgical management of proximal humerus fractures: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:494-498. [PMID: 37928990 PMCID: PMC10624987 DOI: 10.1016/j.xrrt.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Background Currently, there is limited information on the incidence of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE) after surgical treatment of proximal humerus fractures (PHFs). Therefore, the purpose of this systematic review is to evaluate the incidence of VTE, DVT, and PE following surgery for PHFs. Methods A comprehensive search of several databases was performed from inception to May 27, 2022. Studies were screened and evaluated by 2 reviewers independently utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Only original, English studies that evaluated the incidences of VTE following surgical management of PHFs were included. Surgical procedures consisted of shoulder arthroplasty (SA) including both hemiarthroplasty (Hemi) and reverse shoulder arthroplasty (RSA) in addition to open reduction and internal fixation (ORIF). A pooled incidence for postoperative DVT, PE, and overall VTE was reported. Results Twelve studies met the inclusion and exclusion criteria, encompassing a total of 18,238 patients. The overall DVT, PE, and VTE rates were 0.14%, 0.59%, and 0.7%, respectively. VTE was more frequently reported after SA than ORIF, (1.27% vs. 0.53%, respectively). Among SA patients, a higher rate of DVT was seen with RSA (1.2%) with the lowest DVT rate was observed for ORIF with 0.03%. Conclusions Symptomatic VTEs following surgical treatment of PHFs, are rare, yet still relevant as a worrisome postoperative complication. Among the various procedures, VTE was the most frequently reported after SA when compared to ORIF, with RSA having the highest VTE rate.
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Affiliation(s)
- Erick M. Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - John W. Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Rodrigo De Marinis
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
- Shoulder and Elbow Unit, Hospital Dr. Sótero del Río, Santiago, Chile
| | - Puneet Gupta
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Francisco Soza
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
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Lung BE, Donnelly MR, Callan K, McLellan M, Taka T, Stitzlein RN, McMaster WC, So DH, Yang S. Preoperative demographics and laboratory markers may be associated with early dislocation after total hip arthroplasty. J Exp Orthop 2023; 10:100. [PMID: 37801165 PMCID: PMC10558409 DOI: 10.1186/s40634-023-00659-z] [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: 03/05/2023] [Accepted: 09/18/2023] [Indexed: 10/07/2023] Open
Abstract
PURPOSE The purpose of this study was to identify modifiable medical comorbidities, laboratory markers and flaws in perioperative management that increase the risk of acute dislocation in total hip arthroplasty (THA) patients. METHODS All THA with primary indications of osteoarthritis from 2007 to 2020 were queried from the National Surgical Quality Improvement Program (NSQIP) database. Demographic data, preoperative laboratory values, recorded past medical history, operative details as well as outcome and complication information were collected. The study population was divided into two cohorts: non-dislocation and dislocation patients. Statistics were performed to compare the characteristics of both cohorts and to identify risk factors for prosthetic dislocation (α < 0.05). RESULTS 275,107 patients underwent primary THA in 2007 to 2020, of which 1,258 (0.5%) patients experienced a prosthetic hip dislocation. Demographics between non-dislocation and dislocation cohorts varied significantly in that dislocation patients were more likely to be female, older, with lower body mass index and a more extensive past medical history (all p < 0.05). Moreover, hypoalbuminemia and moderate/severe anemia were associated with increased risk of dislocation in a multivariate model (all p < 0.05). Finally, use of general anesthesia, longer operative time, and longer length of hospital stay correlated with greater risk of prosthetic dislocation (all p < 0.05). CONCLUSIONS Elderly female patients and patients with certain abnormal preoperative laboratory values are at risk for sustaining acute dislocations after index THA. Careful interdisciplinary planning and medical optimization should be considered in high-risk patients as dislocations significantly increase the risk of sepsis, cerebral vascular accident, and blood transfusions on readmission.
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Affiliation(s)
- Brandon E Lung
- Irvine School of Medicine, Department of Orthopaedic Surgery, University of California, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA, 92868, USA.
| | - Megan R Donnelly
- Irvine School of Medicine, Department of Orthopaedic Surgery, University of California, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA, 92868, USA
| | - Kylie Callan
- Irvine School of Medicine, Department of Orthopaedic Surgery, University of California, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA, 92868, USA
| | - Maddison McLellan
- Irvine School of Medicine, Department of Orthopaedic Surgery, University of California, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA, 92868, USA
| | - Taha Taka
- Irvine School of Medicine, Department of Orthopaedic Surgery, University of California, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA, 92868, USA
| | - Russell N Stitzlein
- Irvine School of Medicine, Department of Orthopaedic Surgery, University of California, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA, 92868, USA
| | - William C McMaster
- Irvine School of Medicine, Department of Orthopaedic Surgery, University of California, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA, 92868, USA
| | - David H So
- Irvine School of Medicine, Department of Orthopaedic Surgery, University of California, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA, 92868, USA
| | - Steven Yang
- Irvine School of Medicine, Department of Orthopaedic Surgery, University of California, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA, 92868, USA
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Zareef U, Paul RW, Sudah SY, Erickson BJ, Menendez ME. Influence of Race on Utilization and Outcomes in Shoulder Arthroplasty: A Systematic Review. JBJS Rev 2023; 11:01874474-202306000-00015. [PMID: 37335835 DOI: 10.2106/jbjs.rvw.23.00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND Studies have shown that utilization and outcomes after shoulder arthroplasty vary by sociodemographic factors, highlighting disparities in care. This systematic review synthesized all available literature regarding the relationship between utilization and outcomes of shoulder arthroplasty and race/ethnicity. METHODS Studies were identified using PubMed, MEDLINE (through Ovid), and CINAHL databases. All English language studies of Level I through IV evidence that specifically evaluated utilization and/or outcomes of hemiarthroplasty, total shoulder arthroplasty, or reverse shoulder arthroplasty by race and/or ethnicity were included. Outcomes of interest included rates of utilization, readmission, reoperation, revision, and complications. RESULTS Twenty-eight studies met inclusion criteria. Since the 1990s, Black and Hispanic patients have demonstrated a lower utilization rate of shoulder arthroplasty compared with White patients. Although utilization has increased among all racial groups throughout the present decade, the rate of increase is greater for White patients. These differences persist in both low-volume and high-volume centers and are independent of insurance status. Compared with White patients, Black patients have a longer postoperative length of stay after shoulder arthroplasty, worse preoperative and postoperative range of motion, a higher likelihood of 90-day emergency department visits, and a higher rate of postoperative complications including venous thromboembolism, pulmonary embolism, myocardial infarction, acute renal failure, and sepsis. Patient-reported outcomes, including the American Shoulder and Elbow Surgeon's score, did not differ between Black and White patients. Hispanics had a significantly lower revision risk compared with White patients. One-year mortality did not differ significantly between Asians, Black patients, White patients, and Hispanics. CONCLUSION Shoulder arthroplasty utilization and outcomes vary by race and ethnicity. These differences may be partly due to patient factors such as cultural beliefs, preoperative pathology, and access to care, as well as provider factors such as cultural competence and knowledge of health care disparities. LEVEL OF EVIDENCE Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Usman Zareef
- Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Ryan W Paul
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
- Hackensack Meridian School of Medicine, Nutley, New Jersey
| | - Suleiman Y Sudah
- Department of Orthopaedic Surgery, Rutgers Health Monmouth Medical Center, Long Branch, New Jersey
| | - Brandon J Erickson
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, New York, New York
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Agarwal AR, Ahmed AF, Stadecker M, Miller AS, Best MJ, Srikumaran U. Trends in Venous Thromboembolism After Shoulder Arthroplasty in the United States: Analysis Following the 2009 American Academy of Orthopaedic Surgeons Clinical Practical Guidelines. J Am Acad Orthop Surg 2023; 31:364-372. [PMID: 36727919 DOI: 10.5435/jaaos-d-22-00825] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/16/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In 2009, the American Academy of Orthopaedic Surgeons released a consensus recommending venous thromboembolism (VTE) prophylaxis after total shoulder arthroplasty (TSA). The purpose of this study was to examine the (1) change in incidence of 90-day VTE, deep vein thrombosis (DVT), and pulmonary embolism; (2) change in utilization of chemoprophylaxis; and (3) change in the economic burden associated with VTE after TSA from 2010 to 2019. METHODS Using the PearlDiver database, national data from 2010 to 2019 were used to identify patients who underwent primary TSA for osteoarthritis and/or rotator cuff arthropathy. Exclusions entailed liver pathology, coagulopathy, or those on prior prescribed blood thinners before TSA. Multivariable regression was used controlling for age and Charlson Comorbidity Index for all years with 2010 as the reference year. RESULTS From 2010 to 2019, there was a reduction in VTE rates from 0.89% in 2010 to 0.78% in 2019. Regarding implant type, there was no notable change in incidence of VTE, DVT, and pulmonary embolism within 90 days after anatomic TSA. Notable reductions were observed in both VTE and DVT after reverse TSA from 2010 to 2019. Prescribed chemical VTE prophylaxis utilization after TSA markedly increased from 4.41% in 2010 to 11.70% utilization in 2019. The utilization of aspirin markedly increased from 17.27% in 2010 to 65.17% in 2019. Among anticoagulants, the utilization of direct factor Xa inhibitors increased from 0.0% utilization in 2010 to 66.09% utilization in 2019. The added reimbursements associated with VTE after TSA markedly decreased from $14,122 in 2010 to $4,348 in 2019. CONCLUSION The incidence and economic burden associated with VTE after TSA have markedly declined following the 2010 American Academy of Orthopaedic Surgeons clinical practice guidelines. This reduction can be attributed to both an increase in VTE prevention through increased utilization of prescribed chemoprophylaxis and improvement in VTE treatment strategies. LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Amil R Agarwal
- From the Department of Orthopedic Surgery, George Washington Hospital, Washington DC (Agarwal and Stadecker), and the Johns Hopkins Department of Orthopaedic Surgery, Columbia, MD (Agarwal, Ahmed, Miller, Best, and Srikumaran)
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11
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Xia ZH, Chen WH, Wang Q. Risk factors for venous thromboembolism following surgical treatment of fractures: A systematic review and meta-analysis. Int Wound J 2023; 20:995-1007. [PMID: 36382679 PMCID: PMC10030940 DOI: 10.1111/iwj.13949] [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: 06/21/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022] Open
Abstract
This study aimed to determine the risk factors for postoperative venous thromboembolism (VTE) in patients treated surgically for fractures using a meta-analytic approach. Electronic searches were performed in PubMed, Embase, and the Cochrane library from inception until February 2022. The odds ratio (OR) and 95% confidence interval (CI) were applied to calculate the pooled effect estimate using the random-effects model. Sensitivity, subgroup, and publication bias tests were also performed. Forty-four studies involving 3 239 291 patients and reporting 11 768 VTE cases were selected for the meta-analysis. We found that elderly (OR: 1.72; 95% CI: 1.38-2.15; P < .001), American Society of Anesthesiologists (ASA) ≥ 3 (OR: 1.82; 95% CI: 1.46-2.29; P < .001), blood transfusion (OR: 1.82; 95% CI: 1.14-2.92; P = .013), cardiovascular disease (CVD) (OR: 1.40; 95% CI: 1.22-1.61; P < .001), elevated D-dimer (OR: 4.55; 95% CI: 2.08-9.98; P < .001), diabetes mellitus (DM) (OR: 1.36; 95% CI: 1.19-1.54; P < .001), hypertension (OR: 1.31; 95% CI: 1.09-1.56; P = .003), immobility (OR: 3.45; 95% CI: 2.23-5.32; P < .001), lung disease (LD) (OR: 2.40; 95% CI: 1.29-4.47; P = .006), obesity (OR: 1.52; 95% CI: 1.27-1.82; P < .001), peripheral artery disease (PAD) (OR: 2.13; 95% CI: 1.21-3.73; P = .008), prior thromboembolic event (PTE) (OR: 5.17; 95% CI: 3.14-8.50; P < .001), and steroid use (OR: 2.37; 95% CI: 1.73-3.24; P < .001) were associated with an increased risk of VTE. Additionally, regional anaesthesia (OR: 0.66; 95% CI: 0.45-0.96; P = .029) was associated with a reduced risk of VTE following surgical treatment of fractures. However, alcohol intake, cancer, current smoking, deep surgical site infection, fusion surgery, heart failure, hypercholesterolemia, liver and kidney disease, sex, open fracture, operative time, preoperative anticoagulant use, rheumatoid arthritis, and stroke were not associated with the risk of VTE. Post-surgical risk factors for VTE include elderly, ASA ≥ 3, blood transfusion, CVD, elevated D-dimer, DM, hypertension, immobility, LD, obesity, PAD, PTE, and steroid use.
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Affiliation(s)
- Zhen-Hua Xia
- Department of Surgery, Shanghai Shidong Hospital, Shanghai, China
| | - Wei-Hua Chen
- Department of Surgery, Shanghai Shidong Hospital, Shanghai, China
| | - Qun Wang
- Department of Surgery, Shanghai Shidong Hospital, Shanghai, China
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12
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Li T, Li Y, Zhang L, Pang L, Tang X, Zhu J. Venous thromboembolism after arthroscopic shoulder surgery: a systematic review. J Orthop Surg Res 2023; 18:103. [PMID: 36788620 PMCID: PMC9927062 DOI: 10.1186/s13018-023-03592-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
PURPOSE To summarize the incidence, risk factors, diagnosis methods, prophylaxis methods, and treatment of venous thromboembolism (VTE) following arthroscopic shoulder surgery. METHODS Literature on VTE after arthroscopic shoulder surgeries was summarized, and all primary full-text articles reporting at least 1 case of deep vein thrombosis (DVT) or pulmonary embolism (PE) after arthroscopic shoulder surgeries were included. Articles were critically appraised and systematically analyzed to determine the incidence, risk factors, diagnosis, prophylaxis, and management of VTE following arthroscopic shoulder surgeries. RESULTS This study included 42 articles in which the incidence of VTE ranges from 0 to 5.71% and the overall incidence was 0.26%. Most VTE events took place between the operation day and the 14th day after the operation (35/51). Possible risk factors included advanced age (> 70 years), obesity (BMI ≥ 30 kg/m2), diabetes mellitus, thrombophilia, history of VTE, prolonged operation time, hormone use, and immobilization after surgery. The most common prophylaxis method was mechanical prophylaxis (13/15). No statistical difference was detected when chemoprophylaxis was applied. The management included heparinization followed by oral warfarin, warfarin alone and rivaroxaban, a direct oral anticoagulant. CONCLUSION Based on the included studies, the incidence rate of VTE after arthroscopic shoulder surgeries is relatively low. The risk factors for VTE are still unclear. CT/CTA and ultrasound were the mainstream diagnosis methods for PE and DVT, respectively. Current evidence shows that chemical prophylaxis did not deliver significant benefits, since none of the existing studies reported statistically different results. High-quality studies focusing on the prophylaxis and management of VTE population undergoing arthroscopic shoulder surgeries should be done in the future.
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Affiliation(s)
- Tao Li
- grid.13291.380000 0001 0807 1581Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041 Sichuan Province People’s Republic of China
| | - Yinghao Li
- grid.13291.380000 0001 0807 1581Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041 Sichuan Province People’s Republic of China
| | - Linmin Zhang
- grid.13291.380000 0001 0807 1581West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China
| | - Long Pang
- grid.13291.380000 0001 0807 1581Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041 Sichuan Province People’s Republic of China
| | - Xin Tang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan Province, People's Republic of China.
| | - Jing Zhu
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Nursing, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, Sichuan Province, People's Republic of China.
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13
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Lung BE, Kim M, McLellan M, Callan K, Wang ED, McMaster W, Yang S, So DH. Alkaline Phosphatase is an Independent Risk Factor for Periprosthetic Fractures in Total Joint Arthroplasty. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202302000-00007. [PMID: 36763725 PMCID: PMC10566914 DOI: 10.5435/jaaosglobal-d-22-00129] [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: 04/27/2022] [Accepted: 01/06/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Serum alkaline phosphatase (ALP) is a biomarker for chronic low-grade inflammation along with hepatobiliary and bone disorders. High abnormal ALP levels in blood have been associated with metabolic bone disease and high bone turnover. METHODS All primary total hip and knee arthroplasties from 2005 to 2019 were queried from the National Surgical Quality Improvement Program database. Patients with available serum ALP levels were included and stratified to low (<44 IU/L), normal (44 to 147 IU/L), and high (>147 IU/L). A risk-adjusted multivariate logistic regression was used to analyze ALP as an independent risk factor of complications. RESULTS The analysis included 324,592 patients, consisting of 11,427 low ALP, 305,977 normal ALP, and 7,188 high preoperative ALP level patients undergoing total joint arthroplasty. Adjusted multivariate logistic regression analysis showed high ALP level patients had an overall increased risk of readmission within 30 days of surgery compared with the control group (odds ratio [OR], 1.69; P < 0.01). High ALP patients also had an increased risk of postoperative periprosthetic fracture (OR, 1.6), postoperative wound infection (OR, 1.81), pneumonia (OR, 2.24), renal insufficiency (OR, 2.39), cerebrovascular disease (OR, 2.2), postoperative bleeding requiring transfusion (OR, 1.83), sepsis (OR, 2.35), length of stay > 2 days (OR, 1.47), Clostridium difficile infection (OR, 2.07), and discharge to a rehab facility (OR, 1.41) (all P < 0.05). A low ALP level was also associated with increased postoperative bleeding transfusion risk (OR, 1.12; P < 0.01) and developing a deep vein thrombosis (OR, 1.25; P = 0.03). CONCLUSION Abnormal serum ALP levels in patients undergoing primary total joint arthroplasty are associated with increased postoperative periprosthetic fracture risk and medical complications requiring increased length of stay and discharge to a rehabilitation facility.
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Affiliation(s)
- Brandon E. Lung
- From the UC Irvine Department of Orthopaedic Surgery, Orange, CA (Dr. Lung, McLellan, Callan, Dr. McMaster, Dr. Yang, and Dr. So) and the Stony Brook Department of Orthopaedic Surgery, Stony Brook, NY (Kim, and Dr. Wang)
| | - Matthew Kim
- From the UC Irvine Department of Orthopaedic Surgery, Orange, CA (Dr. Lung, McLellan, Callan, Dr. McMaster, Dr. Yang, and Dr. So) and the Stony Brook Department of Orthopaedic Surgery, Stony Brook, NY (Kim, and Dr. Wang)
| | - Maddison McLellan
- From the UC Irvine Department of Orthopaedic Surgery, Orange, CA (Dr. Lung, McLellan, Callan, Dr. McMaster, Dr. Yang, and Dr. So) and the Stony Brook Department of Orthopaedic Surgery, Stony Brook, NY (Kim, and Dr. Wang)
| | - Kylie Callan
- From the UC Irvine Department of Orthopaedic Surgery, Orange, CA (Dr. Lung, McLellan, Callan, Dr. McMaster, Dr. Yang, and Dr. So) and the Stony Brook Department of Orthopaedic Surgery, Stony Brook, NY (Kim, and Dr. Wang)
| | - Edward D. Wang
- From the UC Irvine Department of Orthopaedic Surgery, Orange, CA (Dr. Lung, McLellan, Callan, Dr. McMaster, Dr. Yang, and Dr. So) and the Stony Brook Department of Orthopaedic Surgery, Stony Brook, NY (Kim, and Dr. Wang)
| | - William McMaster
- From the UC Irvine Department of Orthopaedic Surgery, Orange, CA (Dr. Lung, McLellan, Callan, Dr. McMaster, Dr. Yang, and Dr. So) and the Stony Brook Department of Orthopaedic Surgery, Stony Brook, NY (Kim, and Dr. Wang)
| | - Steven Yang
- From the UC Irvine Department of Orthopaedic Surgery, Orange, CA (Dr. Lung, McLellan, Callan, Dr. McMaster, Dr. Yang, and Dr. So) and the Stony Brook Department of Orthopaedic Surgery, Stony Brook, NY (Kim, and Dr. Wang)
| | - David H. So
- From the UC Irvine Department of Orthopaedic Surgery, Orange, CA (Dr. Lung, McLellan, Callan, Dr. McMaster, Dr. Yang, and Dr. So) and the Stony Brook Department of Orthopaedic Surgery, Stony Brook, NY (Kim, and Dr. Wang)
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14
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Lung BE, Donnelly M, Callan K, McLellan M, Amirhekmat A, McMaster WC, So DH, Yang S. Preoperative Malnutrition and Metabolic Markers May Predict Periprosthetic Fractures in Total Hip Arthroplasty. Arthroplast Today 2023; 19:101093. [PMID: 36691463 PMCID: PMC9860454 DOI: 10.1016/j.artd.2022.101093] [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] [Received: 06/20/2022] [Revised: 12/08/2022] [Accepted: 12/20/2022] [Indexed: 01/17/2023] Open
Abstract
Background Periprosthetic fractures are a devastating complication of total hip arthroplasty (THA) and are associated with significantly higher mortality rates in the postoperative period. Given the strain that periprosthetic fractures place on the patient as well as the healthcare system, identifying and optimizing medical comorbidities is essential in reducing complications and improving outcomes. Methods All THA with primary indications of osteoarthritis from 2007 to 2020 were queried from the National Surgical Quality Improvement Program database. Demographic data, preoperative laboratory values, medical comorbidities, hospital course, and acute complications were collected and compared between patients with and without readmission for a periprosthetic fracture. A multivariate logistic regression analysis was performed to determine associated independent risk factors for periprosthetic fractures after index THA. Results The analysis included 275,107 patients, of which 2539 patients were readmitted for periprosthetic fractures. Patients with postoperative fractures were more likely to be older (>65 years), females, BMI >40, and increased medical comorbidities. Preoperative hypoalbuminemia, hyponatremia, and abnormal estimated glomerular filtration rates were independent risk factors for sustaining a periprosthetic fracture and readmission within 30 days. Modifiable patient-related factors of concurrent smoking and chronic steroid use at the time of index THA were also independent risk factors for periprosthetic fractures. Inpatient metrics of longer length of stay, operative time, and discharge to rehab predicted postarthroplasty fracture risk. Readmitted fracture patients subsequently had increased risks of developing a surgical site infection, urinary tract infection, and requiring blood transfusions. Conclusions Patients with hypoalbuminemia, hyponatremia, and abnormal estimated glomerular filtration rate are at increased risk for sustaining periprosthetic fractures after THA. Preoperative optimization with close monitoring of metabolic markers and modifiable risk factors may help not only prevent acute periprosthetic fractures but also associated infection and bleeding risk with fracture readmission.
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Affiliation(s)
- Brandon E. Lung
- Corresponding author. Department of Orthopaedic Surgery, University of California Irvine, 101 City Drive South, PavIII, Orange, CA 92868, USA. Tel.: +1 714 456 7012.
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15
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Llombart R, Mariscal G, Barrios C, de la Rubia Ortí JE, Llombart-Ais R. The Impact of Hypoalbuminemia on Postoperative Complications in Patients Undergoing Shoulder Arthroplasty: A Meta-Analysis. J Nutr Health Aging 2023; 27:1248-1254. [PMID: 38151876 DOI: 10.1007/s12603-023-2050-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/21/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVES The objective of this meta-analysis was to investigate the association between hypoalbuminemia and postoperative complications in patients undergoing shoulder arthroplasty. METHODS This meta-analysis study was registered in PROSPERO (CRD42023442466) and adhered to the PRISMA guidelines. Studies focused on shoulder arthroplasty that compared hypoalbuminemia and normal albumin levels were included. A systematic literature search was conducted in PubMed, EMBASE, Scopus, and the Cochrane Collaboration database. Seven comparative studies were included, and odds ratios with a 95% confidence interval were calculated for the dichotomous variables. A fixed-effect model was used when there was no statistical evidence of heterogeneity, and a random-effect model was used when significant heterogeneity was observed. Review Manager 5.4 software was used for data analysis. RESULTS The meta-analysis included a total of 20,290 patients from seven studies. Hypoalbuminemia was significantly associated with a higher risk of readmissions (OR 2.92, 95%CI 1.74 to 4.91), reoperations (OR 3.23, 95%CI 1.98 to 5.27), an increase in hospital stay duration (MD 1.59, 95%CI 0.86 to 2.32), and complications such as death (OR 5.75, 95% CI 2.98 to 11.08; studies = 4), thromboembolic events (OR 2.43, 95% CI 1.46 to 4.06; studies = 4), cardiac events (OR 2.78, 95% CI 1.07 to 7.24; studies = 3), pulmonary infections (OR 3.09, 95% CI 1.54 to 6.20; studies = 3), systemic infections (OR 2.19, 95% CI 1.51 to 3.16; studies = 3), and transfusions (OR 3.16, 95% CI 2.23 to 4.48; studies = 2). However, there was no significant association between hypoalbuminemia and renal complications, surgical site infections, urinary tract infections, wound problems, or cardiovascular events. CONCLUSION This meta-analysis provides strong evidence that hypoalbuminemia is associated with a higher risk of postoperative complications in patients undergoing shoulder arthroplasty.
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Affiliation(s)
- R Llombart
- Gonzalo Mariscal, Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, Valencia, Spain, Carrer de Quevedo, 2, 46001 València, Valencia, +34649615489, , ORCID: 0000-0002-5166-198X
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Venous Thromboembolism After Total Shoulder Arthroplasty: A Database Study of 31,918 Cases. J Am Acad Orthop Surg 2022; 30:949-956. [PMID: 36135929 DOI: 10.5435/jaaos-d-22-00352] [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: 04/04/2022] [Accepted: 05/25/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), is a rare but serious complication of total shoulder arthroplasty (TSA). Owing to limited evidence, Clinical Practice Guideline recommendations for VTE chemoprophylaxis after TSA rely heavily on the risk stratification of individual patients. The objectives of this study were to identify the prevalence and risk factors independently associated with VTE, PE, and DVT in the 30-day postoperative period after TSA. METHODS A retrospective case-control study was conducted using the American College of Surgeons National Surgical Quality Improvement Program database by querying the Current Procedural Terminology code for total shoulder arthroplasty from 2011 to 2020. The initial query resulted in 33,089 patients. After applying exclusion criteria for age younger than 50 years, emergency surgery, and open wound or infection, a final cohort of 31,918 patients who underwent TSA were included. The primary outcome was venous thromboembolism, and secondary outcome variables were PE and DVT. A bivariate screen was done for explanatory variables associated with our outcome variables, and variables with P < 0.1 in the bivariate screen were included in a multivariable logistic regression model. RESULTS Of the 31,918 patients in our cohort, 183 patients (0.573%) developed VTE, 92 patients (0.29%) developed PE, and 104 patients (0.326%) developed DVT during the 30-day postoperative period. Multivariable logistic regression analysis showed that older age, higher body mass index, longer surgical time, and longer hospital length of stay were associated with VTE and PE and that hypertension and shorter hospital length of stay were associated with DVT. DISCUSSION The prevalence of VTE after TSA is low. Older patients, patients with higher body mass index, and patients with longer surgical durations are at higher risk for VTE after TSA. Our findings are relevant for preoperative risk stratification and the decision for chemoprophylaxis. LEVEL OF EVIDENCE Level III Prognostic.
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Na SS, Kim DH, Choi BC, Cho CH. Incidence, characteristics, and risk factors of venous thromboembolism in shoulder arthroplasty-a systematic review. INTERNATIONAL ORTHOPAEDICS 2022; 46:2081-2088. [PMID: 35761099 DOI: 10.1007/s00264-022-05496-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/21/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE The purpose of this study was to investigate the incidence, characteristics, and risk factors for venous thromboembolism (VTE) in patients who underwent shoulder arthroplasty (SA) through systematic review. METHODS A search of studies was conducted using the databases for PubMed, EMBASE, Scopus, Ovid, MEDLINE, and Cochrane Library according to the guidelines for PRISMA (Preferred Reporting Items for Systematic Meta-Analyses). Quality assessment was performed using the Methodological Index for Nonrandomized Studies (MINORS). RESULTS Nine studies (12,566 shoulders) were finally eligible and the mean MINORS score was 13.2 (ranges, 9-18). The overall incidence of VTE was 0.81% (78/9681) including 0.54% (52/9681) for deep vein thrombosis (DVT) and 0.33% (42/12,566) for pulmonary embolism (PE). There were no significant differences in the incidences according to the type of arthroplasty. DVT was detected at an average of 18.8 days after index surgery, and PE was detected at an average of 12.7 days after index surgery. The risk factors for VTE included age older than 70 years, higher BMI, raised Charlson Comorbidity Index, history of DVT, asthma, cardiac arrhythmia, diabetes, lower haemoglobin level, use of general endotracheal anaesthesia without interscalene nerve block, traumatic indication, longer operative time, and revision SA. The mortality rate was 4.1% (2/49) for VTE and 8.3% (2/24) for PE. CONCLUSION Despite the fact that the overall incidence of VTE following SA was as low as 0.81%, shoulder surgeons should consider the potential for this serious complication in high-risk patients. Further well-designed large-scale studies are necessary to clarify the consensus for VTE after SA including risk factors, treatment, and prophylaxis.
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Affiliation(s)
- Sang-Soo Na
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubeol-daero, Dalseo-gu, Daegu, 42601, South Korea
| | - Du-Han Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubeol-daero, Dalseo-gu, Daegu, 42601, South Korea
| | - Byung-Chan Choi
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubeol-daero, Dalseo-gu, Daegu, 42601, South Korea
| | - Chul-Hyun Cho
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubeol-daero, Dalseo-gu, Daegu, 42601, South Korea.
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Hu X, Li X, Xu H, Zheng W, Wang J, Wang W, Li S, Zhang N, Wang Y, Han K. Development of Risk Prediction Model for Muscular Calf Vein Thrombosis with Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Int J Gen Med 2022; 15:6549-6560. [PMID: 35974801 PMCID: PMC9375990 DOI: 10.2147/ijgm.s374777] [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: 05/15/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aims to establish a risk prediction model for muscular calf vein thrombosis (MCVT) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods The research sample consisted of 248 patients with AECOPD and all of them underwent vascular ultrasounds of both lower limbs in this retrospective study. Univariate analysis and multivariate logistic regression analysis were conducted on factors with significant group differences to screen for the independent risk factors of MCVT. A nomogram to predict the risk of MCVT was constructed and validated with bootstrap resampling. Results According to the exclusion criteria, 240 patients were included for analysis, divided into the MCVT group (n = 81) and the non-MCVT group (n = 159). Multivariate logistic regression analyses showed that hypertension, elevated MPV, reduced albumin (ALB), elevated D-dimer and bed rest ≥3 days were independent risk factors for MCVT in AECOPD. A nomogram model for predicting AECOPD with MCVT was established based on them. The area under the curve (AUC) of receiver operating characteristic (ROC) curve for the prediction model and the simplified Wells score was 0.784 (95% CI: 0.722–0.847) and 0.659 (95% CI: 0.583–0.735), respectively. The cut-off value and Youden index of prediction model were 0.248 and 0.454, respectively. At the same time, the sensitivity, specificity, positive predictive value, and negative predictive value of the prediction model were 85.9%, 59.5%, 84.6%, and 77.4%, respectively. The sensitivity and specificity of the simplified Wells score were 67.9% and 56.3%, respectively. Validation by the use of bootstrap resampling revealed optimal discrimination and calibration, and the decision analysis curve (DAC) suggested that this prediction model involved high clinical practicability. Conclusion We developed a nomogram that can predict the risk of MCVT for AECOPD patients. This model has the potential to assist clinicians in making treatment recommendations and formulating corresponding prevention measures.
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Affiliation(s)
- Xiaoman Hu
- Department of Respiratory and Critical Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Xincheng Li
- Department of Respiratory and Critical Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Huifen Xu
- Department of Respiratory and Critical Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Weili Zheng
- Department of Respiratory and Critical Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Jian Wang
- Department of Respiratory and Critical Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Wenyu Wang
- Department of Respiratory and Critical Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Senxu Li
- Department of Respiratory and Critical Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Ning Zhang
- Department of Respiratory and Critical Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Yunpeng Wang
- Department of Respiratory and Critical Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Kaiyu Han
- Department of Respiratory and Critical Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
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King HE, Ricketts D, Roper T, Phadnis J. Few UK vascular centres offer a fully NICE-compliant supervised exercise programme: a national audit. Ann R Coll Surg Engl 2022; 104:130-137. [PMID: 34982604 PMCID: PMC9246563 DOI: 10.1308/rcsann.2021.0221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION To determine the current (pre-COVID-19) provision of supervised exercise training (SET) for patients with peripheral arterial disease (PAD) in UK Vascular Centres. METHODS Hospital Trusts delivering vascular care to patients with PAD were identified from the National Vascular Registry and asked to complete an online questionnaire on their provisions for SET. If a centre offered SET, they were asked questions to determine whether the programme was compliant with NICE guidelines and the difficulties they faced delivering the service. If centres did not offer SET, they were asked what obstacles prevented them implement SET. RESULTS Of the 78 UK vascular centres, 59 (76%) responded and were included in the audit. Of these, 27 (46%) were able to offer SET but only 21 (36%) could offer it to all their patients with PAD. Only four (6.8%) offered SET that was fully compliant with current NICE guidelines. Reasons identified included insufficient funding, lack of resource and poor patient compliance. CONCLUSIONS The benefits of SET are well established yet the availability of the service in the UK is poor. The reasons for this are readily identified but have not yet been overcome. Research on novel methods of delivering supervised exercise that mitigates existing barriers, such as home exercise with remote monitoring, should be prioritised to facilitate optimal management for our patients with PAD.
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Affiliation(s)
- HE King
- University Hospitals Sussex NHS Foundation Trust, UK
| | | | - T Roper
- University Hospitals Sussex NHS Foundation Trust, UK
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Kim M, Ling K, Nazemi A, Tantone R, Kashanchi K, Lung B, Komatsu DE, Wang ED. Abnormal Preoperative Platelet Count May Predict Postoperative Complications Following Shoulder Arthroplasty. JSES Int 2022; 6:935-941. [PMID: 36353411 PMCID: PMC9637646 DOI: 10.1016/j.jseint.2022.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background The purpose of this study is to investigate the association between preoperative platelet counts and postoperative complication rates within 30 days of total shoulder arthroplasty (TSA). Methods The American College of Surgeons National Surgical Quality Improvement database was queried for all patients who underwent TSA between 2015 and 2019. The study population was then divided into 5 groups based on their preoperative platelet count: <100k (moderate-to-severe thrombocytopenia), 100-150k (mild thrombocytopenia), 150-200k (low-normal preoperative platelet count), 200-450k (normal, reference cohort), and >450k (thrombocytosis). Postoperative complications within 30 days of the TSA were collected. Multivariate logistic regression analysis was conducted to investigate the relationship between preoperative platelet counts and postoperative complications. Results A total of 19,721 patients undergoing TSA between 2015 and 2019 were included in this study. One hundred fifty-five patients (0.8%) had moderate-to-severe thrombocytopenia, 982 (5.0%) had mild thrombocytopenia, 3945 (20.0%) had a low-normal preoperative platelet count, 14,386 (72.9%) had a normal preoperative platelet count, and 253 (1.3%) had thrombocytosis. An increasing rate of overall complications was observed as the severity of thrombocytopenia progressed from low-normal (6.4%) to mild thrombocytopenia (10.2%) and to moderate-to-severe thrombocytopenia (18.7%). The overall complication rate of the thrombocytosis cohort was 14.6%. In comparison to normal platelet count, low-normal thrombocytopenia, mild thrombocytopenia, moderate-to-severe thrombocytopenia, and thrombocytosis were identified by multivariate analysis as significant predictors of overall complications (odds ratios [ORs] of 1.12, 2.15, 2.43, 2.71, respectively), postoperative anemia requiring transfusion (ORs of 1.63, 3.45, 5.97, 4.21, respectively), and minor complications (ORs of 1.39, 2.64, 3.40, 3.34, respectively). Minor complications include progressive renal insufficiency, urinary tract infection, transfusions within 72 hours after surgery, pneumonia, and superficial incisional surgical site infection. Conclusion Increasing severity of thrombocytopenia correlated with higher overall postoperative complication rates following TSA. Interestingly, patients with thrombocytosis had the highest overall postoperative complication rates among all cohorts included in this study. Platelet counts are often the reflection of other comorbidities and a good indicator of patient's general health status. Long-term optimization of abnormal platelet counts may potentially reduce surgical complications.
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Affiliation(s)
- Matthew Kim
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Kenny Ling
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Alireza Nazemi
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - Ryan Tantone
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - Kevin Kashanchi
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Brandon Lung
- Department of Orthopaedics, UCI, Orange, CA, USA
| | - David E. Komatsu
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - Edward D. Wang
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
- Corresponding author: Edward D. Wang, MD, Department of Orthopaedics and Rehabilitation, Stony Brook University Hospital, HSC T-18, Room 080, Stony Brook, NY 11794-8181, USA.
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Zwart SR, Auñón-Chancellor SM, Heer M, Melin MM, Smith SM. Albumin, Oral Contraceptives, and Venous Thromboembolism Risk in Astronauts. J Appl Physiol (1985) 2022; 132:1232-1239. [PMID: 35389755 PMCID: PMC9126217 DOI: 10.1152/japplphysiol.00024.2022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND A venous thromboembolism (VTE) event occurred in a female astronaut during long-duration spaceflight. Multiple factors may have contributed to this risk, including the use of combined (progestin + estrogen) oral contraceptives (cOC). METHODS Biochemistry data from 65 astronauts were evaluated for associations with cOC use and with sex. RESULTS The female astronauts who used cOCs had lower concentrations of serum albumin and higher concentrations of transferrin, a protein involved in the clotting cascade, than the male astronauts and the female astronauts who were not taking cOCs (P<0.001). The women who used cOCs had higher serum concentrations of the acute phase reactant ceruloplasmin during flight and cortisol (P<0.001) than the men and the women who were not taking cOCs; they also had higher calculated whole blood viscosity than women not taking cOCs (P<0.001). CONCLUSIONS Lower circulating concentrations of albumin, higher concentrations of transferrin, and elevated markers of inflammation all could contribute to an increased risk of VTE during spaceflight. These changes, in association with a higher blood viscosity can directly affect endothelial glycocalyx integrity and hypercoagulability status, both of which contribute to VTE risk in terrestrial populations.
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Affiliation(s)
- Sara R Zwart
- University of Texas Medical Branch, Galveston, TX, United States
| | - Serena M Auñón-Chancellor
- LSU Health New Orleans School of Medicine, Baton Rouge, LA, United States.,NASA Johnson Space Center, Houston, TX, United States
| | - Martina Heer
- IU International University of Applied Sciences and University of Bonn, Bonn, Germany
| | - M Mark Melin
- M Health Fairview (University of Minnesota Physicians), Edina, MN, United States
| | - Scott M Smith
- NASA Johnson Space Center, Houston, TX, United States
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24
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Abstract
Orthopedic sports surgery of the knee and shoulder is generally considered to be safe and effective. Vascular complications can occur during or after arthroscopy of either joint. A thorough understanding of anatomy, particularly when placing portals in non-routine locations, is extremely important. Prompt recognition of any vascular complication is of significant importance. This review will discuss the potential vascular complications for both knee and shoulder sports surgery, review the relevant anatomy, and discuss the treatment and expected outcome of each.
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Doany ME, Ling K, Jeong R, Nazemi A, Komatsu DE, Wang ED. Comparison of Early Range of Motion in Reverse Shoulder Arthroplasty Based on Indication: A Single Center Retrospective Review. J Shoulder Elb Arthroplast 2022; 6:24715492221108283. [PMID: 35719846 PMCID: PMC9203724 DOI: 10.1177/24715492221108283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/08/2022] [Accepted: 06/02/2022] [Indexed: 11/15/2022] Open
Abstract
Background Reverse shoulder arthroplasty (RSA) is commonly used in the treatment of rotator cuff arthropathy. Indications for RSA have expanded to include complex proximal humerus fractures. Studies directly comparing outcomes between traumatic and traditional elective indications are limited. The purpose of this study was to compare early active range of motion (aROM) within the first two years postoperatively between traumatic and non-traumatic primary RSA, as well as compare ASES scores, and patient satisfaction at final follow-up. Methods A retrospective analysis was conducted of all RSA performed by a single surgeon between January 2000 and December 2018. Patients were grouped by indication into traumatic and non-traumatic elective groups. Demographics, surgical data, and routine aROM data were collected. aROM was compared at 3, 6, 12, and 24 months. American Shoulder and Elbow Surgeons (ASES) score and patient satisfaction were determined at the time of this investigation. Results 367 RSA procedures were performed by the senior author during the study period, 88 for fracture (24%), and 279 for non-traumatic elective indications (76%). Forward elevation and external rotation were inferior in the fracture group at all time points in the first two years. Internal rotation was equivalent throughout the first two years. Final ASES scores were 77.6 versus 83.5 in the fracture and non-fracture groups, respectively (p = .33). Conclusion Patients undergoing RSA for fracture had statistically significant inferior aROM in forward elevation and external rotation throughout the first two years. Despite having inferior aROM, ASES scores and patient satisfaction at final follow-up were statistically equivalent. Level of Evidence Level III; Retrospective Cohort Comparision; Prognosis Study
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Affiliation(s)
- Michael E Doany
- Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Kenny Ling
- Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Rosen Jeong
- Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Alireza Nazemi
- Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - David E Komatsu
- Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Edward D Wang
- Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
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Mancini MR, LeVasseur MR, Hawthorne BC, Marrero DE, Mazzocca AD. Venous thromboembolism complications in shoulder surgery: current concepts. J ISAKOS 2021; 6:283-289. [PMID: 34535553 DOI: 10.1136/jisakos-2020-000538] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 02/01/2021] [Accepted: 02/09/2021] [Indexed: 11/04/2022]
Abstract
Venous thromboembolism (VTE) is a rare yet known complication of shoulder surgery. Concerning shoulder arthroplasty, reported rates of VTE range from 0.2% to 16%. Unlike many lower extremity procedures, particularly total hip and knee arthroplasty, chemical prophylactic guidelines for VTE in shoulder surgeries have not been established. Some argue that doing so is unnecessary. On the contrary, mechanical prophylaxis is nearly universally accepted in shoulder surgery, particularly for more lengthy procedures. With limited VTE incidence in shoulder surgery, treatment is anecdotally derived from the hip and knee arthroplasty literature. Recent studies have successfully identified risk factors for VTE related to the patient and to the surgery itself. Awareness of these risk factors by the surgeon and declaration of these factors to the patient should be discussed as part of the informed consent process. Further investigational studies and larger patient cohorts will be necessary to optimise VTE prevention in shoulder surgeries.
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Affiliation(s)
- Michael R Mancini
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Matthew R LeVasseur
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Benjamin C Hawthorne
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Daniel E Marrero
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
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Tan Z, Hu H, Wang Z, Wang Y, Zhang Y. Prevalence and risk factors of preoperative deep venous thrombosis in closed patella fracture: a prospective cohort study. J Orthop Surg Res 2021; 16:404. [PMID: 34162417 PMCID: PMC8220698 DOI: 10.1186/s13018-021-02558-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/15/2021] [Indexed: 11/12/2022] Open
Abstract
Background The preoperative prevalence of deep venous thromboembolism (DVT) of patella fracture is not well established. The study aimed to investigate the preoperative prevalence, the associated risk factors, and the locations of deep venous thrombosis (DVT) in patients with closed patella fracture. Methods Patients who sustained closed patella fracture between January 1, 2016, and April 1, 2019, were included. Blood analyses and ultrasonography of bilateral lower extremities were routinely performed. Data of demographics, comorbidities, mechanism of injury, fracture type, total hospital stay, time from injury to DVT, and laboratory indexes were prospectively collected and compared between groups with and with non-DVT. Multivariate logistic regression analyses were performed to determine the independent risk factors of DVT. Results Among the study cohort of 790 patients, 35 cases occurred in preoperative DVTs, indicating a prevalence of 4.4%, with 3.2% distal and 1.2% proximal DVT. Age ≥ 65 years old (OR, 3.0, 95% CI, 1.1–8.1), D-dimer > 0.5 mg/L (OR, 2.3, 95% CI, 1.1–4.8), and albumin < 35 g/L (OR, 2.5, 95% CI, 1.2–5.3) were identified to be risk factors of DVT in closed patella fracture. Among the DVTs, 30 cases (85.7%) occurred in the injured extremity, 3 cases (8.6%) in bilateral extremities, and 2 cases (5.7%) solely in the uninjured extremity. Conclusion The prevalence of preoperative DVT in closed patella fracture was 4.4%, with 3.2% for distal and 1.2% for proximal DVT. We recommend individualized risk stratification and early anticoagulation for patients with risk factors (age ≥ 65 years, D-dimer > 0.5 mg/L and albumin < 35g/L).
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Affiliation(s)
- Zhanchao Tan
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Hongzhi Hu
- Department of Orthopedics, Union Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zhongzheng Wang
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Yuchuan Wang
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China. .,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China. .,NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
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Salomon B, Dasa V, Krause PC, Hall L, Chapple AG. Hospital Length of Stay Is Associated With Increased Likelihood for Venous Thromboembolism After Total Joint Arthroplasty. Arthroplast Today 2021; 8:254-257.e1. [PMID: 34095400 PMCID: PMC8167317 DOI: 10.1016/j.artd.2020.12.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/06/2020] [Accepted: 12/20/2020] [Indexed: 02/06/2023] Open
Abstract
Background The prevalence of venous thromboembolism (VTE) after total joint arthroplasty (TJA) is 0.40%-1.2%. Trends in TJA are for shorter hospital stays with lower complication rates. The aim of this study is to evaluate whether hospital length of stay (LOS) is associated with risk of a thromboembolic event after TJA. Methods This was a retrospective study of patients undergoing TJA during 2013-2017 at Louisiana and Texas hospitals. Univariable analyses and multivariable logistic regression examined patient characteristics (sex, race, age, body mass index, Charlson Comorbidity Index, TJA type, and LOS) associated with experiencing a VTE event after discharge and before 1-year follow-up. Results Of the 13,969 patients who met inclusion criteria, 338 (2.4%) had a VTE event after discharge. In multivariable regression analysis, more severe comorbidities (odds ratio: 1.30, 95% confidence interval: 1.23-1.37; P < .001) and LOS days (odds ratio: 1.07, 95% confidence interval: 1.01 to 1.14; P = .0215) were associated with an increased risk of VTE. Conclusion Patients with more severe comorbidities or a longer LOS had a greater risk of VTE after discharge following TJA.
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Affiliation(s)
- Brett Salomon
- LSU HSC NO School of Medicine, New Orleans, LA, USA
- Corresponding author. 1901 Perdido Street, New Orleans, LA 70112, USA. Tel.: +1 504 655 6754.
| | - Vinod Dasa
- LSU HSC NO Department of Orthopaedics, New Orleans, LA, USA
| | | | - Lauren Hall
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Andrew G. Chapple
- LSU HSC NO Department of Public Health and Biostatistics, New Orleans, LA, USA
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Ma J, Du P, Qin J, Zhou Y, Liang N, Hu J, Zhang Y, Zhu Y. Incidence and risk factors predicting deep venous thrombosis of lower extremity following spinal fractures. Sci Rep 2021; 11:2441. [PMID: 33510388 PMCID: PMC7843965 DOI: 10.1038/s41598-021-82147-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/15/2021] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to investigate the presence of preoperative DVT following spinal fracture and the association between the presence of DVT and risk factors. Ultrasonography and blood analyses were performed preoperatively in patients diagnosed with spinal fracture between October 2014 and December 2018. Univariate analyses were performed on the data of demographics, comorbidities, location of injury, spinal cord injury (SCI) grading and laboratory biomarkers. The receiver operating characteristic (ROC) curve analysis was employed to obtain the optimal D-dimer cut-off value for diagnosis. In total, 2432 patients with spinal fractures were included, among whom 108 (4.4%) patients had preoperative DVTs. The average interval between fracture and initial diagnosis of DVT was 4.7 days (median, 2 days), ranging from 0 to 20 days; 78 (72.2%) were diagnosed within 7 days after injury and 67 (62.0%) within 3 days; 19 (17.5%) patients had proximal vein involved and 89 (82.4%) presented in distal veins. Multivariate logistic regression suggested six risk factors independently correlated to DVT, including delay to DUS (in each day) (odds ratio [OR] = 1.11), ASA class III-IV (OR = 2.36), ASIA grade (A/B) (OR = 2.36), ALB < 3.5 g/dL (OR = 2.08), HDL-C < 1.1 mmol/L (OR = 1.68) and D-Dimer > 1.08 µg/ml (OR = 2.49).
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Affiliation(s)
- Jiangtao Ma
- Hebei Orthopedic Clinical Research Center, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Pei Du
- Department of Infection Control and Prevention, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Jin Qin
- Hebei Orthopedic Clinical Research Center, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Yali Zhou
- Hebei Orthopedic Clinical Research Center, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Ningxi Liang
- Hebei Orthopedic Clinical Research Center, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Jinglve Hu
- Hebei Orthopedic Clinical Research Center, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China. .,Orthopaedic Institution of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China. .,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China. .,Chinese Academy of Engineering, Beijing, 100088, People's Republic of China.
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China. .,Orthopaedic Institution of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China. .,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China.
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Preoperative incidence and locations of deep venous thrombosis (DVT) of lower extremity following ankle fractures. Sci Rep 2020; 10:10266. [PMID: 32581237 PMCID: PMC7314767 DOI: 10.1038/s41598-020-67365-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/04/2020] [Indexed: 11/18/2022] Open
Abstract
This retrospective study aimed to investigate the preoperative incidence and locations of deep venous thrombosis (DVT) in patients undergoing surgeries for ankle fractures and identify the associated risk factors. From January 2016 to June 2019, 1,532 patients undergoing surgery of ankle fractures were included. Their inpatient medical records were inquired for data collection, including demographics, comorbidities, injury-related data and preoperative laboratory biomarkers. DVT of bilateral lower extremities was diagnosed by routine preoperative Doppler examination. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors. Totally, 98 patients had a preoperative DVT, indicating an incidence rate of 6.4%. A total of 164 clots for 6 veins were found, representing an average of 1.7 for each patient. The detailed DVTs involving veins were as follows: 2 in femoral common vein, 7 in superficial femoral vein, 2 in deep femoral vein, 16 in popliteal vein, 49 in posterior tibial vein, and 88 in peroneal vein. In the multivariate model, 5 risk factors were identified to be associated with DVT, including age (10-year increase), gender, lower ALB level, reduced LYM count and elevated D-dimer level. There was a tendency for diabetes mellitus to increase the risk of DVT, although there was no statistical significance (p = 0.063). These epidemiologic data on DVT may help counsel patients about the risk of DVT, individualized risk assessment and accordingly the risk stratification.
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Shen C, Ge B, Liu X, Chen H, Qin Y, Shen H. Predicting the occurrence of venous thromboembolism: construction and verification of risk warning model. BMC Cardiovasc Disord 2020; 20:249. [PMID: 32460701 PMCID: PMC7251685 DOI: 10.1186/s12872-020-01519-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 05/10/2020] [Indexed: 12/12/2022] Open
Abstract
Background The onset of venous thromboembolism is insidious and the prognosis is poor. In this study, we aimed to construct a VTE risk warning model and testified its clinical application value. Methods Preliminary construction of the VTE risk warning model was carried out according to the independent risk warning indicators of VTE screened by Logistic regression analysis. The truncated value of screening VTE was obtained and the model was evaluated. ROC curve analysis was used to compare the test of Caprini risk assessment scale and VTE risk warning model. The cut-off value of the VTE risk warning model was used to evaluate the test effectiveness of the model for VTE patients with validation data set. Results The VTE risk warning model is p = ex / (1+ ex), x = − 4.840 + 2.557 • X10(1) + 1.432 • X14(1) + 2.977 • X15(1) + 3.445 • X18(1) + 1.086 • X25(1) + 0.249 • X34 + 0.282 • X41. ROC curve results show that: AUC (95%CI), cutoff value, sensitivity, specificity, accuracy, Youden index, Caprini risk assessment scale is 0.596 (0.552, 0.638), 5, 26.07, 96.50, 61.3%, 0.226, VTE risk warning model is 0.960 (0.940, 0.976), 0.438, 92.61, 91.83, 92.2%, 0.844, respectively, with statistically significant differences (Z = 14.521, P < 0.0001). The accuracy and Youden index of VTE screening using VTE risk warning model were 81.8 and 62.5%, respectively. Conclusions VTE risk warning model had high accuracy in predicting VTE occurrence in hospitalized patients. Its test performance was better than Caprini risk assessment scale. It also had high test performance in external population.
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Affiliation(s)
- Chen Shen
- Department of Nursing, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong City, 226000, Jiangsu, China
| | - Binqian Ge
- School of Nursing, Suzhou Vocational Health College, 28 Kehua Road, Suzhou City, 215009, Jiangsu, China
| | - Xiaoqin Liu
- Department of Nursing, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong City, 226000, Jiangsu, China
| | - Hao Chen
- Department of Information, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong City, 226000, Jiangsu, China
| | - Yi Qin
- Department of Nursing, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong City, 226000, Jiangsu, China
| | - Hongwu Shen
- Department of Nursing, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong City, 226000, Jiangsu, China.
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