1
|
Brown RB. Non-Specific Low Back Pain, Dietary Salt Intake, and Posterior Lumbar Subcutaneous Edema. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159158. [PMID: 35954516 PMCID: PMC9368517 DOI: 10.3390/ijerph19159158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/16/2022] [Accepted: 07/25/2022] [Indexed: 12/10/2022]
Abstract
Low back pain is the world’s leading disability, but the etiology of the majority of low back pain is non-specific with no known cause. Moreover, overuse of opioids to treat low back pain is a widespread problem. This paper proposes that non-specific low back pain may be associated with excessive intake of dietary salt, potentially mediated by posterior lumbar subcutaneous edema. In addition to pain, symptoms of edema include swelling, tightness, and stiff joints, which are common complaints of people with low back pain, along with restricted lumbar range of motion and impaired mobility. Many global populations consume excess sodium chloride, which can lead to fluid overload in hypervolemia, and cause swelling and temporary weight gain associated with low back pain. Numerous conditions comorbid with low back pain are also potentially mediated by excessive salt intake, including migraine headache, hypertension, cardiovascular disease, venous thromboembolism, liver disease, respiratory disorders, chronic kidney disease, pregnancy complications, and multiple sclerosis. Novel approaches to identify and prevent the cause of non-specific low back pain have potential to reduce disability worldwide by reducing low back pain prevalence. More research is needed to confirm the involvement of dietary salt and posterior lumbar subcutaneous edema in non-specific low back pain.
Collapse
Affiliation(s)
- Ronald B Brown
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| |
Collapse
|
2
|
Rhoads C, Emara AK, Pumo T, Pan X, Zhou G, Koroukian S, Krebs VE, Piuzzi NS. What Are the Drivers of Readmission for Serious Venous Thromboembolic Events after Primary Total Knee Arthroplasty? An Analysis of 862,915 Patients. J Knee Surg 2022. [PMID: 35798344 DOI: 10.1055/s-0042-1750063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Venous thromboembolism (VTE) is a relatively common complication among patients undergoing primary total knee arthroplasty (TKA). This complication occurs in a spectrum of severity ranging from an incidental finding to serious readmission-requiring events. To date, the risk factors of serious VTE that require readmission have not been characterized. This study examines the patient and hospital characteristics associated with readmission for serious VTE after TKA. The National Readmission Database (NRD) from the Agency of Healthcare Research and Quality (AHRQ) was queried for patients who underwent primary TKA from January 2016-December 2018. The study population consisted of patients who were readmitted within 90 days following primary TKA with a primary diagnosis of VTE. Multivariable regression models were constructed to evaluate patient characteristics (age, sex, insurance, elective nature of procedure, hospital characteristics, discharge status, income, and comorbidities) associated with higher risk of developing readmission-requiring VTE. Readmission rates for VTE exhibited a higher incidence in patients older than 61 (compared with 40 and under), males (OR:1.08, 95%CI [1.03-1.14]), patients with nonelective procedures (OR:20.21, 95% CI [19.16-21.32]), patients at large hospitals(OR:1.17, 95% CI [1.09-1.25]), patients at private hospitals (OR:1.19, 95% CI [1.09-1.29]), and patients with non-home discharge statuses. Comorbidities of paralysis (OR:1.52, 95% CI [1.19-1.94]), neurological disorders (OR:1.12, 95% CI [1.02-1.23]), metastatic cancer (OR:1.48, 95% CI [1.01-2.17]), obesity (OR:1.11, 95% CI [1.06-1.17]), fluid and electrolyte imbalance (OR:1.28, 95% CI [1.18-1.38]), blood loss anemia (OR:1.29, 95% CI [1.02-1.64]), and iron deficiency anemia (OR:1.24, 95 % CI [1.15-1.33]) increased risk of VTE. Certain comorbidities requiring chronic anticoagulation were associated with lower risk of VTE. Insurance status and patient income did not exhibit any correlation with VTE incidence. Patient characteristics of male sex, age > 61, and baseline comorbidities (paralysis, neurological disorders, metastatic cancer, obesity, fluid and electrolyte imbalance, and blood loss/iron deficiency anemia) were at an increased risk of developing serious VTE. Patients without continued supervision at their discharge environment were at higher risk of developing serious VTE. Extra prophylaxis and special protocols may be warranted in these patients to prevent VTE complications.
Collapse
Affiliation(s)
- Colin Rhoads
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Pumo
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Xuankang Pan
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Case Western Reserve University, School of Medicine, Cleveland, Ohio
| | - Guangjin Zhou
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Siran Koroukian
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Viktor E Krebs
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
3
|
Zhao WG, Zhang WL, Zhang YZ. Characteristics of Deep Venous Thrombosis in Isolated Lower Extremity Fractures and Unsolved Problems in Guidelines: A Review of Recent Literature. Orthop Surg 2022; 14:1558-1568. [PMID: 35633091 PMCID: PMC9363729 DOI: 10.1111/os.13306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 02/21/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022] Open
Abstract
Deep venous thrombosis (DVT) has been characterized by a disorder of venous return caused by abnormal blood clotting in deep veins. It often occurs in the lower limbs and is a common complication in orthopaedics. Therefore, relevant professional organizations domestic and overseas had formulated and constantly updated relevant guidelines to prevent the occurrence of DVT. According to the management strategy of the guidelines, the incidence of DVT can be significantly reduced. However, due to the variety of fractures types, the guidelines cannot expound precautions and characteristics of DVT for all fracture types at present, and there are other related unresolved problems. For example, there is still a lack of consistent optimal strategies for the management of DVT following isolated lower extremity fractures with a higher incidence. The best anticoagulant strategies for patients with upper limb fractures, pediatric fractures, and those combined with other injuries are rarely described in orthopaedic guidelines, but such fractures are common in clinical orthopaedics. The long‐term complications after DVT, such as post‐thrombotic syndrome, are not well‐understood. In the absence of clear guidance, orthopaedic surgeons often resort to empiric anticoagulation or conservative treatment, so the prevention effects of DVT are inconsistent. The purpose of this review is to summarize the characteristics of DVT events after isolated lower extremity fractures and to discuss the unsolved issues in the guidelines by reviewing the previous literature and tracing the history of DVT discovery, to provide more scientific and comprehensive recommendations for the prediction and prevention of DVT.
Collapse
Affiliation(s)
- Wei-Guang Zhao
- Department of Orthopedic Surgery, Handan Central Hospital, HanDan, China
| | - Wei-Li Zhang
- Department of Orthopedic Surgery, Handan Central Hospital, HanDan, China
| | - Ying-Ze Zhang
- Department of Trauma Emergency Center, The Third Hospital of Hebei Medical University, Orthopaedics Research Institution of Hebei Province, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China.,Chinese Academy of Engineering, Beijing, China
| |
Collapse
|
4
|
Wei C, Gu A, Muthiah A, Fassihi SC, Sculco PK, Nunley RM, Bernstein BA, Liu J, Berger JS. Neuraxial anaesthesia is associated with improved outcomes and reduced postoperative complications in patients undergoing aseptic revision total hip arthroplasty. Hip Int 2022; 32:221-230. [PMID: 33241947 DOI: 10.1177/1120700020975749] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND As the incidence of primary total hip arthroplasty (THA) continues to increase, revision THA (rTHA) is becoming an increasingly common procedure. rTHA is widely regarded as a more challenging procedure, with higher complication rates and increased medical, social and economic burdens when compared to its primary counterpart. Given the complexity of rTHA and the projected increase in incidence of these procedures, patient optimisation is becoming of interest to improve outcomes. Anaesthetic choice has been extensively studied in primary THA as a modifiable risk factor for postoperative outcomes, showing favourable results for neuraxial anaesthesia compared to general anaesthesia. The impact of anaesthetic choice in rTHA has not been studied previously. METHODS A retrospective study was performed using the American College of Surgeons National Surgical Quality Improvement Program database. Patients who underwent rTHA between 2014 and 2017 were divided into 3 anaesthesia cohorts: general anaesthesia, neuraxial anaesthesia, and combined general-regional (neuraxial and/or peripheral nerve block) anaesthesia. Univariate and multivariate analyses were used to analyse patient characteristics and 30-day postoperative outcomes. Bonferroni correction was applied for post-hoc analysis. RESULTS In total, 5759 patients were identified. Of these, 3551 (61.7%) patients underwent general anaesthesia, 1513 (26.3%) patients underwent neuraxial anaesthesia, and 695 (12.1%) patients underwent combined general-regional anaesthesia. On multivariate analysis, neuraxial anaesthesia was associated with decreased odds for any-one complication (OR 0.635; p < 0.001), perioperative blood transfusion (OR 0.641; p < 0.001), and extended length of stay (OR 0.005; p = 0.005) compared to general anaesthesia. CONCLUSIONS Relative to those receiving general anaesthesia, patients undergoing neuraxial anaesthesia are at decreased risk for postoperative complications, perioperative blood transfusions, and extended length of stay. Prospective controlled trials should be conducted to verify these findings.
Collapse
Affiliation(s)
- Chapman Wei
- Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Alex Gu
- Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Arun Muthiah
- Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Safa C Fassihi
- Department of Orthopaedic Surgery, George Washington University Hospital, Washington DC, USA
| | - Peter K Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Ryan M Nunley
- Department of Orthopedic Surgery, Washington University at St Louis, St. Louis, MO
| | - Brad A Bernstein
- Department of Anesthesiology, St Louis University School of Medicine, St. Louis, MO, USA
| | - Jiabin Liu
- Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA
| | - Jeffrey S Berger
- Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| |
Collapse
|
5
|
Ding K, Wang H, Jia Y, Zhao Y, Yang W, Chen W, Zhu Y. Incidence and risk factors associated with preoperative deep venous thrombosis in the young and middle-aged patients after hip fracture. J Orthop Surg Res 2022; 17:15. [PMID: 35016710 PMCID: PMC8753898 DOI: 10.1186/s13018-021-02902-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/30/2021] [Indexed: 11/21/2022] Open
Abstract
Objective This study aims to investigate the incidence, occurrence timing and locations of preoperative DVT and identify the associated factors in this group.
Methods A retrospective analysis of collected data in young and middle-aged (18–59 years) patients who presented with hip fracture between October 2015 and December 2018 was conducted. Before operation, patients were routinely examined for DVT by Duplex ultrasonography (DUS). Electronic medical records were retrieved to collect the data, involving demographics, comorbidities, injury and laboratory biomarkers after admission. Multivariate logistic regression analysis was performed to identify factors that were independently associated with DVT. Results Eight hundred and fifty-seven patients were included, and 51 (6.0%) were diagnosed with preoperative DVT, with 2.5% for proximal DVT. The average age of patients with DVT is 48.7 ± 9.4 year, while that of patients without DVT is 45.0 ± 10.9 year. The mean time from injury to diagnosis of DVT was 6.8 ± 5.5 days, 43.1% cases occurring at day 2–4 after injury. Among 51 patients with DVT, 97 thrombi were found. Most patients had thrombi at injured extremity (72.5%), 19.6% at uninjured and 7.8% at bilateral extremities. There are significantly difference between patients with DVT and patients without DVT in term of prevalence of total protein (41.2% vs 24.4%, P = 0.008), albumin (54.9% vs 25.6%, P = 0.001), low lactate dehydrogenase (51.0% vs 30.3%, P = 0.002), lower serum sodium concentration (60.8% vs 29.9%, P = 0.001), lower RBC count (68.6% vs 37.0%, P = 0.001), lower HGB (51.0% vs 35.1%, P = 0.022), higher HCT (86.3% vs 35.1%, P = 0.022) and higher platelet count (37.3% vs 11.3%, P = 0.001). The multivariate analyses showed increasing age in year (OR 1.04, 95% CI; P = 0.020), delay to DUS (OR, 1.26; P = 0.001), abnormal LDH (OR, 1.45; P = 0.026), lower serum sodium concentration (OR, 2.56; P = 0.007), and higher HCT level (OR, 4.11; P = 0.003) were independently associated with DVT. Conclusion These findings could be beneficial in informed preventive of DVT and optimized management of hip fracture in specific group of young and mid-aged patients.
Collapse
Affiliation(s)
- Kai Ding
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Haicheng Wang
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yuxuan Jia
- Department of 2017 Clinical Medicine, School of Class 4, Basic Medicine, Hebei Medical University, Shijiazhuang, Hebei Province, People's Republic of China
| | - Yan Zhao
- School of Nursing, Hebei Medical University, Shijiazhuang, 050000, Hebei, People's Republic of China
| | - Weijie Yang
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Wei Chen
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China. .,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China. .,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China. .,NHC Key Laboratory of Intelligent Orthopeadic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, People's Republic of China.
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China. .,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China. .,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
| |
Collapse
|
6
|
Chang MT, Jitaroon K, Song S, Roozdar P, Wangworat Y, Ibrahim N, Ma Y, Rao VK, Chang SD, Fernandez-Miranda JC, Patel ZM, Dodd RL, Hwang PH, Harsh GR, Nayak JV. Venous thromboembolism rates and risk factors following endoscopic skull base surgery. Int Forum Allergy Rhinol 2021; 12:935-941. [PMID: 34894093 DOI: 10.1002/alr.22943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/05/2021] [Accepted: 12/08/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a potentially fatal perioperative complication. The objective of this study was to assess the rate and risk factors for VTE in endoscopic skull base surgery (ESBS). METHODS This was a retrospective review of adults undergoing ESBS at a tertiary academic center. Incidence of VTE in the 30-day postoperative period was recorded. Logistic regression analyses identified factors associated with VTE. RESULTS 1122 ESBS cases between 2009 and 2019 were studied. Almost no cases (96.1%) employed perioperative VTE chemoprophylaxis. The overall incidence of VTE was 2.3% (26/1122). Malignant pathologies had a higher rate of VTE compared to nonmalignant pathologies (4.5% vs 2.0%, OR 2.85, 95%CI 1.22-6.66). Factors associated with an increased risk of VTE included a Caprini score greater than 5 (OR 1.53, 95% CI 1.28-1.83); multiple preoperative endocrinopathies such as the syndrome of inappropriate antidiuretic hormone secretion (SIADH) (OR 22.48, 95% CI 3.93-128.70), adrenal insufficiency (OR 5.24, 95% CI 1.82-15.03), hypercortisolism (OR 4.46, 95% CI 1.47-13.56), and hypothyroidism (OR 3.69, 95% CI 1.66-8.20), each 10-hour increment of lumbar drain duration (OR 1.16, 95%CI 1.08-1.25), and each 10-hour increment for duration of hospitalization (OR 1.05, 95% CI 1.03-1.06). CONCLUSIONS The incidence of VTE following ESBS is relatively low. Factors with a higher association with VTE include malignancy, preoperative endocrinopathies, higher Caprini score, prolonged lumbar drain duration, and prolonged hospitalization. Further study is needed to validate these findings and to refine clinical decision making around perioperative VTE prophylaxis. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Michael T Chang
- Division of Rhinology/Endoscopic Skull Base Surgery, Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Kawinyarat Jitaroon
- Department of Otolaryngology, Navamindradhiraj University, Bangkok, Thailand
| | - Sunhee Song
- Department of Otolaryngology-Head & Neck Surgery, Daegu Veterans Hospital, Daegu, Republic of Korea
| | - Pooya Roozdar
- Division of Rhinology/Endoscopic Skull Base Surgery, Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Yossawee Wangworat
- Department of Otolaryngology, Thammasat University, Pathumthani, Thailand
| | - Nour Ibrahim
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Yifei Ma
- Division of Rhinology/Endoscopic Skull Base Surgery, Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Vidya K Rao
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Steven D Chang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Zara M Patel
- Division of Rhinology/Endoscopic Skull Base Surgery, Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Robert L Dodd
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Peter H Hwang
- Division of Rhinology/Endoscopic Skull Base Surgery, Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Griffith R Harsh
- Department of Neurosurgery, University of California-Davis, School of Medicine, Sacramento, CA, USA
| | - Jayakar V Nayak
- Division of Rhinology/Endoscopic Skull Base Surgery, Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA.,Division of Otolaryngology - Head & Neck Surgery, Palo Alto VA Health Care System (PAVAHCS), Palo Alto, CA, USA
| |
Collapse
|
7
|
Zhu Y, Chen W, Li J, Zhao K, Zhang J, Meng H, Zhang Y, Zhang Q. Incidence and locations of preoperative deep venous thrombosis (DVT) of lower extremity following tibial plateau fractures: a prospective cohort study. J Orthop Surg Res 2021; 16:113. [PMID: 33546695 PMCID: PMC7863261 DOI: 10.1186/s13018-021-02259-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/25/2021] [Indexed: 12/22/2022] Open
Abstract
Background There is still lack of data on deep vein thrombosis (DVT) following bone trauma. This study aimed to determine the epidemiologic characteristics of deep venous thrombosis (DVT) of lower extremities following tibial plateau fractures. Methods Retrospective analysis of prospectively collected data on patients presenting with tibial plateau fractures between October 2014 and December 2018 was conducted. Duplex ultrasonography (DUS) was routinely used to screen for preoperative DVT of bilateral lower extremities. Data on demographics, comorbidities, injury-related data, and laboratory biomarkers at admission were collected. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors associated with DVT. Results A total of 1179 patients were included, among whom 192 (16.3%) had a preoperative DVT, with incidence rate of 1.0% for proximal and 15.3% for distal DVT. The average interval between fracture occurrence and diagnosis of DVT was 3.5 days (median, 2 days), ranging from 0 to 19 days. DVT involved the injured extremity in 166 (86.4%) patients, both the injured and uninjured extremities in 14 patients (7.3%) and only the uninjured extremity in 12 patients (6.3%). Six risk factors were identified to be associated with DVT, including gender (male vs female), hypertension, open fracture, alkaline phosphatase > 100 u/L, sodium concentration < 135 mmol/L, and D-dimer > 0.5 mg/L. Conclusion These epidemiologic data are conducive to the individualized assessment, risk stratification, and development of targeted prevention programs.
Collapse
Affiliation(s)
- Yanbin Zhu
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Wei Chen
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Junyong Li
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Kuo Zhao
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Junzhe Zhang
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Hongyu Meng
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China. .,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China. .,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China. .,Chinese Academy of Engineering, Beijing, 100088, People's Republic of China. .,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Shijiazhuang, Hebei, 050051, P.R. China.
| | - Qi Zhang
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China. .,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China. .,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
| |
Collapse
|
8
|
Hyponatremia-Long-Term Prognostic Factor for Nonfatal Pulmonary Embolism. Diagnostics (Basel) 2021; 11:diagnostics11020214. [PMID: 33535666 PMCID: PMC7912854 DOI: 10.3390/diagnostics11020214] [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: 12/11/2020] [Revised: 01/24/2021] [Accepted: 01/27/2021] [Indexed: 11/17/2022] Open
Abstract
Over recent years, studies have shown that in patients with left-sided heart failure, arterial hypertension, and acute coronary syndrome, hyponatremia is a negative prognostic factor. In this context, there is raising interest in the association between hyponatremia and pulmonary embolism (PE). This retrospective cohort study includes 404 consecutive patients with confirmed acute nonfatal pulmonary embolism divided into four groups according to their sodium fluctuation pattern. The primary outcome was all-cause mortality and determining the recurrence rate among patients with nonfatal PE using serum sodium levels as a continuous variable. Patients with acquired and persistent hyponatremia had a significantly higher rate of mortality rate than those in the normonatremia group (12.8% and 40.4%, OR- 7.206, CI: 2.383-21.791, p = 0.000 and OR-33.250, CI: 11.521-95.960, p = 0.000 vs. 2%, p < 0.001, respectively). Mean survival time decreases from 23.624 months (95% CI: (23.295-23.953)) in the normonatremia group to 16.426 months (95% CI: (13.17-19.134)) in the persistent hyponatremia group, statistically significant (p = 0.000). The mean survival time for all patients was 22.441 months (95% CI: (21.930-22.951)). The highest recurrence rate was recorded at 12 and 24 months in the acquired hyponatremia group (16.7% and 14.1%, respectively). Serum sodium determination is a simple and cost-effective approach in evaluating the short and long-term prognosis in patients with acute PE.
Collapse
|
9
|
Li J, Zhu Y, Chen W, Zhao K, Zhang J, Meng H, Jin Z, Ye D, Zhang Y. Incidence and locations of deep venous thrombosis of the lower extremity following surgeries of tibial plateau fractures: a prospective cohort study. J Orthop Surg Res 2020; 15:605. [PMID: 33317585 PMCID: PMC7735415 DOI: 10.1186/s13018-020-02136-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/30/2020] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To investigate the incidence of deep venous thrombosis (DVT) of the lower extremities following surgeries of tibial plateau fractures. METHODS Retrospective analysis of the prospectively collected data on patients undergoing surgeries of tibial plateau fractures between October 2014 and December 2018 was conducted. Duplex ultrasonography (DUS) was used to screen for postoperative DVT of the bilateral lower extremities. Data on demographics, comorbidities, injury, surgery, and laboratory biomarkers at admission were collected. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors associated with DVT. RESULTS Among 987 patients included, 46 (4.7%) had postoperative DVT, with incidence rate of 1.0% for proximal and 3.7% for distal DVT. The average interval between operation and DVT was 8.3 days (median, 5.8 days), ranging from 2 to 42 days. DVT involved the injured extremity in 39 (84.8%) patients, both the injured and uninjured extremity in 2 patients (4.3%) and only the uninjured extremity in 5 patients (10.9%). Five risk factors were identified to be associated with postoperative DVT, including age (≥ 41 vs < 41 years) (OR 3.08; 95% CI 1.43-6.61; p = 0.004), anesthesia (general vs regional) (OR 2.08; 95% CI 1.12-3.85; p = 0.021), hyponatremia (OR 2.21; 95% CI 1.21-4.06; p = 0.010), prolonged surgical time (OR 1.04; 95% CI 1.01-1.07; p = 0.017) and elevated D-dimer level (OR 2.79; 95% CI 1.34-4.83; p = 0.004). CONCLUSION These epidemiologic data may be helpful in individualized assessment, risk stratification, and development of targeted prevention programs.
Collapse
Affiliation(s)
- Junyong Li
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, PR China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,The Second Hospital of Shijiazhuang City, Shijiazhuang, 050051, Hebei, PR China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei, 050051, Shijiazhuang, People's Republic of China
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, PR China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei, 050051, Shijiazhuang, People's Republic of China
| | - Wei Chen
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, PR China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei, 050051, Shijiazhuang, People's Republic of China
| | - Kuo Zhao
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, PR China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei, 050051, Shijiazhuang, People's Republic of China
| | - Junzhe Zhang
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, PR China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei, 050051, Shijiazhuang, People's Republic of China
| | - Hongyu Meng
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, PR China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei, 050051, Shijiazhuang, People's Republic of China
| | - Zhucheng Jin
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, PR China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei, 050051, Shijiazhuang, People's Republic of China
| | - Dandan Ye
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei, 050051, Shijiazhuang, People's Republic of China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, PR China. .,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, PR China. .,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, PR China. .,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei, 050051, Shijiazhuang, People's Republic of China.
| |
Collapse
|
10
|
Ma J, Qin J, Hu J, Shang M, Zhou Y, Liang N, Zhang Y, Zhu Y. Incidence and Hematological Biomarkers Associated With Preoperative Deep Venous Thrombosis Following Foot Fractures. Foot Ankle Int 2020; 41:1563-1570. [PMID: 32806946 DOI: 10.1177/1071100720943844] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study was designed to investigate the incidence and hematological biomarker levels that are associated with deep venous thrombosis (DVT) following closed foot fractures (except calcaneal fractures). METHODS A retrospective analysis of data on patients presenting with closed foot fractures (excluding the calcaneus) between October 2014 and December 2018 was conducted. Duplex ultrasonography was used to screen preoperative DVT of bilateral lower extremities. Data on demographics, comorbidities, types of fracture, and laboratory biomarkers at admission were collected. Univariate analyses and multivariate logistic regression analyses were carried out to determine the independent risk factors associated with DVT. RESULTS A total of 537 patients were included, among whom 28 patients had preoperative DVTs, indicating a crude incidence rate of 5.2%. In isolated closed foot fractures, DVT occurred in 12 (2.9%) out of 410 patients, while in patients with concurrent fracture in other locations, 16 (12.6%) out of 127 patients developed DVT. The average interval between fracture occurrence and diagnosis of DVT was 4.2 days (median, 2 days), ranging from 0 to 17 days. Twenty-four patients (85.7%) developed DVT in the injured extremity, 3 (10.7%) in the uninjured extremity, and 1 (3.5%) in bilateral extremities. Seven risk factors were identified to be associated with DVT, including alcohol consumption, concomitant other fractures, platelet distribution width (PDW) <12%, high-density lipoprotein cholesterol (HDL-C) <1.1mmol/L, serum alkaline phosphatase (ALP) >100 U/L, serum sodium concentration (Na+) <135 mmol/L, and D-dimer >0.5 mg/L. CONCLUSION Being aware of the prevalence of DVT in closed foot fractures can help physicians to carry out the overall assessment, risk stratification, and individual prevention programs. LEVEL OF EVIDENCE Level III, a prospective cohort study.
Collapse
Affiliation(s)
- Jiangtao Ma
- Hebei Orthopedic Clinical Research Center, the 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Jin Qin
- Hebei Orthopedic Clinical Research Center, the 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Jinglve Hu
- Hebei Orthopedic Clinical Research Center, the 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Meishuang Shang
- Hebei Orthopedic Clinical Research Center, the 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Yali Zhou
- Hebei Orthopedic Clinical Research Center, the 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Ningxi Liang
- Hebei Orthopedic Clinical Research Center, the 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, the 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,Chinese Academy of Engineering, Beijing, People's Republic of China
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, the 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| |
Collapse
|