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Subramanian SA, Kim HN, Kim S, Hwang J, Lee DI, Rhim HC, Kim SJ, Schon L, Sung IH. Long-Term Survival Analysis of 5619 Total Ankle Arthroplasty and Patient Risk Factors for Failure. J Clin Med 2023; 13:179. [PMID: 38202186 PMCID: PMC10779937 DOI: 10.3390/jcm13010179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Total ankle arthroplasty (TAA) has higher complication and failure rates compared to other surgical joint replacement procedures despite technological advances. This study aimed to find the long-term survivability of the TAA procedure and identify the patient risk factors for failure with one of the largest cohorts of patients in the literature. METHODS This retrospective cohort study involving cases between 2007 and 2018 analyzed patients who received an index primary TAA procedure in Korea. A total of 5619 cases were included in the final analysis. The TAA failure was defined as either a case with revision arthroplasty or a case with TAA implant removal and arthrodesis performed after primary TAA. RESULTS During the study period, the 5-year survival rate was 95.4% (95% CI, 94.7-96.1%), and the 10-year survival rate was 91.1% (95% CI, 89.1-93.1%). A younger age (<55 years, adjusted hazard ratio [AHR], 1.725; 55-64 years, AHR, 1.812; p < 0.001 for both), chronic pulmonary disease (AHR, 1.476; p = 0.013), diabetes (AHR, 1.443; p = 0.014), and alcohol abuse (AHR, 1.524; p = 0.032) showed a significantly high odds ratio for primary TAA failure in Cox regression analysis. CONCLUSION The 10-year TAA survivorship rate was 91.1%. A younger age, chronic pulmonary disease, diabetes, and heavy alcohol consumption are risk factors for TAA.
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Affiliation(s)
- Sivakumar Allur Subramanian
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea
| | - Hyong Nyun Kim
- Department of Orthopedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea
| | - SeongHyeon Kim
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea
| | - Jihyun Hwang
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Dong I. Lee
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Hye Chang Rhim
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02129, USA
| | - Sung Jae Kim
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea
| | - Lew Schon
- Center for Orthopaedic Innovation, Mercy Medical Center, Baltimore, MD 21202, USA
- Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD 21202, USA
| | - Il-Hoon Sung
- Department of Orthopedic Surgery, Hanyang University Hospital, Seoul 04763, Republic of Korea
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Challoumas D, Munn D, Stockdale H, Ng N, McCormick M, Altell T, Joiya S, Horton J, Jones B. Outcomes of total hip and knee arthroplasty in special populations: a synopsis and critical appraisal of systematic reviews. ARTHROPLASTY 2023; 5:34. [PMID: 37408050 DOI: 10.1186/s42836-023-00190-7] [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: 03/06/2023] [Accepted: 04/23/2023] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION This study aimed to present and critically appraise the best available evidence investigating associations between some pre-defined patient-related characteristics and perioperative complications or other outcomes in THA and TKA. METHODS Electronic databases were searched (Medline, EMBASE, Scopus, CENTRAL) for systematic reviews assessing the following pre-defined patient-related characteristics as possible risk factors for worse peri-operative outcomes in THA and TKA: smoking, alcohol excess, rheumatoid arthritis, human immunodeficiency virus infection, hepatitis C virus infection, mental health conditions, and solid organ transplantation. Our primary outcome was periprosthetic joint infection. Results were analysed separately for THA, TKA and THA/TKA (mixed data). RESULTS Based on at least two systematic reviews being in agreement, the following patient-related characteristics were associated with increased incidence of complications as follows: a) Smoking for all-cause revision in THA, for periprosthetic joint infection in TKA and THA/TKA; b) alcohol excess for periprosthetic joint infection in THA/TKA; c) human immunodeficiency virus for periprosthetic joint infection in THA/TKA; d) hepatitis C virus for overall complications, periprosthetic joint infection and all-cause revision in THA and THA/TKA, and for overall complications in TKA. Our study found conflicting evidence for a) smoking as a risk factor for periprosthetic joint infection and aseptic loosening in THA; b) human immunodeficiency virus as a risk factor for all-cause revision for THA/TKA; c) hepatitis C virus as a risk factor for periprosthetic joint infection and all-cause revision in TKA. No certainty of evidence was assigned to these results as this was not assessed by the authors of the majority of the included systematic reviews. CONCLUSION We found that smoking, excess alcohol consumption, RA, and infection with HIV and HCV were associated with a higher incidence of periprosthetic joint infection in one or both of THA and TKA or mixed THA/TKA data. All our results should be interpreted and communicated to patients with caution as the quality of the included systematic reviews was generally poor.
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Affiliation(s)
- Dimitris Challoumas
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK.
| | - David Munn
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
| | - Henrietta Stockdale
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
| | - Nigel Ng
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
| | - Michael McCormick
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
| | - Tareq Altell
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
| | - Shaheer Joiya
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
| | - James Horton
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
| | - Bryn Jones
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
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Zaniletti I, Larson DR, Lewallen DG, Berry DJ, Kremers HM. How to Distinguish Correlation From Causation in Orthopaedic Research. J Arthroplasty 2023; 38:634-637. [PMID: 36481283 PMCID: PMC10010939 DOI: 10.1016/j.arth.2022.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/14/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Correlations in observational studies are commonly misinterpreted as causation. Although correlation is necessary to establish a causal relationship between two variables, correlations may also arise due to chance, reverse causality, or confounding. There are several methods available to orthopaedic researchers to determine whether the observed correlations are causal. These methods depend on the key components of the study including, but not limited to, study design and data availability on confounders. In this article, we illustrate the main concepts surrounding correlation and causation using intuitive real-world examples from the orthopaedic literature. Please visit the following https://www.youtube.com/watch?v=WW7pFudZbHA&t=52s for a video that explains the highlights of the paper in practical terms.
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Affiliation(s)
- Isabella Zaniletti
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, USA
| | - Dirk R. Larson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - David G. Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel J. Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Hilal Maradit Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Shakya P, Poudel S. Prehabilitation in Patients before Major Surgery: A Review Article. JNMA J Nepal Med Assoc 2022; 60:909-915. [PMID: 36705159 PMCID: PMC9924929 DOI: 10.31729/jnma.7545] [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: 06/12/2022] [Accepted: 09/03/2022] [Indexed: 01/28/2023] Open
Abstract
The overall outcome of the patient after any surgery is determined not only by the fineness of the surgical procedure but also by preoperative conditioning and postoperative care. Prehabilitation decreases the surgical stress response and increases the preparedness of the patient to undergo planned surgical insult. Preoperatively structured inspiratory muscle exercises, cardiopulmonary fitness program, and planned exercise program for muscles of limbs, back, abdomen, head, and neck allow an overall upliftment of the physiological capacity of the patient to better cope with the surgical stress. Optimization of dietary status by macronutrients, micronutrients, and the nutrients has an impact on augmenting postoperative recovery and shortening the overall hospital stay. Preparing patients for the scheduled surgery and initiating alcohol and smoking cessation programs overhaul the patient's mental health and boost the healing process. This concept of prehabilitation a few weeks before surgery is equally beneficial compared to enhancing operative procedures and postsurgical care. Keywords length of stay; mental health; nutrients; preoperative exercise; smoking cessation.
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Affiliation(s)
- Pawan Shakya
- Department of Surgery, Ramechhap District Hospital, Ramechhap Bazaar, Ramechhap, Nepal,Correspondence: Dr Pawan Shakya, Department of Surgery, Ramechhap District Hospital, Ramechhap Bazaar, Ramechhap, Nepal. , Phone: +977-9860224103
| | - Sagar Poudel
- Department of Surgery, Ramechhap District Hospital, Ramechhap Bazaar, Ramechhap, Nepal
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Barretto JM, Campos ALS, Ooka NHM. Periprosthetic Knee Infection - Part 1: Risk Factors, Classification and Diagnosis. Rev Bras Ortop 2022; 57:185-192. [PMID: 35652026 PMCID: PMC9142234 DOI: 10.1055/s-0041-1729935] [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: 11/06/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022] Open
Abstract
Infection is one of the most feared complications in the postoperative period of knee arthroplasties. With the progressive aging of the population and the increased incidence of degenerative joint diseases, there is an exponential increase in the number of arthroplasties performed and, consequently, in the number of postoperative infections. The diagnosis of these should follow a hierarchical protocol, with well-defined criteria, which lead to diagnostic conclusion, thus guiding the most appropriate treatment. The aim of the present update article is to present the main risk factors, classifications and, mainly, to guide diagnostic investigation in an organized manner.
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Affiliation(s)
| | - André Luiz Siqueira Campos
- Departamento de Ortopedia e Traumatologista, Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brasil
| | - Nelson Hiroyuki Miyabe Ooka
- Departamento de Ortopedia e Traumatologista, Hospital Universitário Pedro Ernesto, Rio de Janeiro, RJ, Brasil.,Departamento de Ortopedia e Traumatologista, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, RJ, Brasil
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Li Z, Hu G, Zhu Y, Xu F, Ye J, Guan J, Guan H. Factors Associated with Shoulder Range of Motion After Arthroscopic Rotator Cuff Repair: A Hospital‐Based Prospective Study. Orthop Surg 2022; 14:1309-1316. [PMID: 35603551 PMCID: PMC9251286 DOI: 10.1111/os.13249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/09/2022] [Accepted: 02/18/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To assess the factors associated with outcomes of arthroscopic surgical repair of rotator cuff tears (RCTs). Method This prospective study recruited patients, at least 18 years old, who underwent arthroscopic rotator cuff repair for full‐thickness RCTs at the First People's Hospital of Hangzhou Xiaoshan between July 2019 and October 2020. Patient demographics, lifestyle habits, and medical histories were collected preoperatively; RCT sizes and affected tendons were determined intraoperatively. Outcomes were assessed by shoulder range of motion (ROM) determinations 1.5 and 3 months postoperatively. The factors associated with ROM were determined using a binary logistic regression analysis, and the results were expressed as adjusted relative risks (RRs) and 95% confidence intervals (CIs). Results A total of 132 patients with RCTs underwent arthroscopic surgery. Five were lost to follow‐up, leaving 127 patients (mean age, 59 years; 58.3% women) who were included in the study analysis. The majority of the patients (54.5%) had RCTs that were classified as large or massive, and approximately 20% had tears involving multiple tendons; 80.3% of the patients had tears involving only a single tendon. Moreover, 29.9% of the patients had hypertension and 11.0% had diabetes. Among the patients, 23.0% were smokers and 34.6% drank alcohol. According to the multivariate analysis, none of the assessed factors were associated with shoulder ROM at the 1.5‐month follow‐up. At the 3‐month follow‐up, RCTs involving a single tendon demonstrated 3‐fold better abduction (RR = 4.00; 95% CI, 1.30–12.33; P = 0.016) and 3.15‐fold better internal rotation (RR = 3.15; 95% CI, 1.19–8.36; P = 0.021) than did RCTs involving multiple tendons. Patients who did not drink alcohol demonstrated 6.08‐fold better anteflexion (RR = 7.08; 95% CI, 2.11–23.73; P = 0.002) and nearly 4‐fold better abduction (RR = 4.97; 95% CI, 1.62–15.23; P = 0.005) than patients who drank alcohol. Conclusion To improve outcomes, the results indicate that more targeted measures should be directed toward patients with multiple‐tendon RCTs and that preoperative alcohol abstinence education is needed for patients with RCTs.
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Affiliation(s)
- Zhennan Li
- The Second Clinical Medicine College Zhejiang Chinese Medical University Hangzhou China
| | - Gangfeng Hu
- Department of Orthopaedics The First People's Hospital of Xiaoshan District, Hangzhou, Zhejiang, China
| | - Yuan Zhu
- Department of Orthopaedics The First People's Hospital of Xiaoshan District, Hangzhou, Zhejiang, China
| | - Fangqi Xu
- Department of Orthopaedics The First People's Hospital of Xiaoshan District, Hangzhou, Zhejiang, China
| | - Jiakuan Ye
- Department of Orthopaedics The First People's Hospital of Xiaoshan District, Hangzhou, Zhejiang, China
| | - Jie Guan
- Department of Orthopaedics The First People's Hospital of Xiaoshan District, Hangzhou, Zhejiang, China
| | - Hong Guan
- The Second Clinical Medicine College Zhejiang Chinese Medical University Hangzhou China
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Impact of Smoking and Drinking on Complications After Revision Total Joint Arthroplasty: A Matched Cohort Analysis. J Am Acad Orthop Surg 2021; 29:e769-e781. [PMID: 32947345 DOI: 10.5435/jaaos-d-20-00795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/18/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Smoking and drinking have been shown to impair postoperative outcomes in primary hip and knee total joint arthroplasty (TJA). This study aimed to evaluate the potential impact of smoking and drinking on complications after revision TJA. METHODS We retrospectively evaluated a total of 4,302 consecutive patients who underwent revision TJA. Patient demographics and complications were compared between four cohorts based on smoking and drinking status: (1) nonusers (nonsmokers and nondrinkers), (2) smokers, (3) drinkers, and (4) concurrent users. RESULTS A total of 1,924 patients were matched using propensity score analysis: 808 nonusers (42.0%), 421 smokers (21.9%), 483 drinkers (25.0%), and 212 concurrent users (11.1%). When compared with nonusers, smokers, drinkers, and concurrent users (simultaneous smokers and drinkers) exhibited higher odds for both inhospital complications (odds ratios, smokers: 2.40, drinkers: 1.55, and concurrent users: 5.13, P < 0.01). Among the user cohorts, although smokers and drinkers showed similar rates of 90-day postdischarge complications (smokers: 14.95% and drinkers: 14.80%, P = 0.95), concurrent users demonstrated the highest significant odds for these complications (odds ratio, 1.64, P = 0.02). DISCUSSION Our propensity-score-matched cohort study results demonstrate that although the smokers and drinkers groups shared similarly poor outcomes after discharge, concurrent users were found to have the worst outcomes compared with either single user group.
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Zhang X, Chen X, Yang J, Du L, Zhou Y, Li K. Meta-analysis of alcohol consumption and venous thromboembolism. J Public Health (Oxf) 2021; 44:477-498. [PMID: 33824981 DOI: 10.1093/pubmed/fdab045] [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: 07/11/2020] [Revised: 12/20/2020] [Accepted: 02/12/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The associations of alcohol consumption and venous thromboembolism (VTE) have been investigated widely, but the conclusions were inconsistent. OBJECTIVE To summarize the relationship of alcohol consumption and VTE. METHODS This study has been registered in PROSPERO (ID: CRD42020164567). We searched the PubMed, Embase, Web of Science and the Cochrane Library databases from inception to September 2019 and reviewed the reference list of relevant articles to identify studies assessing the association between alcohol consumption and risk of VTE. RESULTS Fourteen cohorts and four case-control studies were included in the meta-analysis. Compared with non-drinkers, the risk of VTE was decreased (RR: 0.93; 95% confidence interval [CI] 0.88-0.99) for alcohol drinkers. The pooled RRs of VTE were 0.91 (95% CI 0.84-0.99) for low to moderate alcohol intake (0.1-14.0 drinks/week) and 0.91 (95% CI 0.78-1.06) for high alcohol intake (>14.0 drinks/week) compared with non-drinker. Subgroup analysis showed liquor intake might slightly increase the risk of VTE (1.01; 95% CI 0.85-1.21) although the difference was not significant. CONCLUSIONS Alcohol consumption in low to moderate was associated with a lower risk of VTE. However, precautions are needed when providing personal drinking advice considering the potential harm of alcohol. Further studies are warranted to determine whether moderate alcohol consumption has a causal role in VTE.
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Affiliation(s)
- Xingxia Zhang
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xinrong Chen
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jie Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Liang Du
- Chinese Evidence-based Medicine/Cochrane Center, Chengdu 610041, China
| | - Yong Zhou
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ka Li
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu 610041, China
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9
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Liu WC, Liu HE, Kao YW, Qin L, Lin KC, Fang CY, Tsai LL, Shia BC, Wu SY. Definitive intensity-modulated radiotherapy or surgery for early oral cavity squamous cell carcinoma: Propensity-score-matched, nationwide, population-based cohort study. Head Neck 2020; 43:1142-1152. [PMID: 33314548 DOI: 10.1002/hed.26575] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/27/2020] [Accepted: 11/30/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND No evidence is currently available to estimate the outcomes of intensity-modulated radiation therapy (IMRT) and surgery for patients with early oral cavity squamous cell carcinoma (E-OCSCC). METHODS We recruited patients from the Taiwan Cancer Registry Database who had received a diagnosis of E-OCSCC. Propensity score matching was performed, and Cox proportional hazards model was used to analyze all-cause mortality. RESULTS In the multivariate Cox regression analyses, the adjusted hazard ratio (aHR) (95% confidence interval [CI]) for surgery compared with definitive IMRT, T2N0M0 compared with T1N0M0, and male patients compared with female patients were 0.303 (0.245, 0.375), 1.340 (1.077, 1.668), and 2.012 (1.432, 2.826), respectively. The aHRs (95% CIs) for age 61 to 70, 71 to 80, and ≧81 years compared with <40 years were 2.984 (1.43, 4.225), 3.353 (2.578, 4.112), and 4.277 (4.104, 5.679), respectively. CONCLUSIONS For patients with E-OCSCC, surgery may be considered the first option rather than definitive IMRT.
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Affiliation(s)
- Wen-Chi Liu
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gang University, Taoyuan, Taiwan.,Telehealth Telecare Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsueh-Erh Liu
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gang University, Taoyuan, Taiwan.,Department of Rheumatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Nursing, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Yi-Wei Kao
- Graduate Institute of Business Administration, Fu Jen Catholic University, Taipei, Taiwan
| | - Lei Qin
- School of Statistics, University of International Business and Economics, Beijing, China
| | - Kuan-Chou Lin
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chih-Yuan Fang
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Lo-Lin Tsai
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ben-Chang Shia
- Graduate Institute of Business Administration, Fu Jen Catholic University, Taipei, Taiwan
| | - Szu-Yuan Wu
- Graduate Institute of Business Administration, Fu Jen Catholic University, Taipei, Taiwan.,Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan.,Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan.,Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan.,Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.,Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
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10
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Liu WC, Liu HE, Kao YW, Qin L, Lin KC, Fang CY, Tsai LL, Shia BC, Wu SY. Definitive radiotherapy or surgery for early oral squamous cell carcinoma in old and very old patients: A propensity-score-matched, nationwide, population-based cohort study. Radiother Oncol 2020; 151:214-221. [PMID: 32866564 DOI: 10.1016/j.radonc.2020.08.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Although patients aged >70 years are subject to early oral cavity squamous cell carcinoma (E-OCSCC), evidence is currently lacking regarding the probable outcomes of definitive radiotherapy (RT) compared to surgery in this population. METHODS We recruited patients aged ≥70 years with a diagnosis of E-OCSCC from the Taiwan Cancer Registry Database. Propensity score matching was performed, and Cox proportional-hazards model curves were used to analyze all-cause mortality of patients at different age intervals undergoing different treatments. RESULTS The matching process yielded a final cohort of 604 patients in the definitive RT and surgery cohorts who were eligible for further analysis. These patients were classified as old (70-80 years) and very old (>80 years). In the multivariate Cox regression analysis, the adjusted hazard ratio (aHR) (95% confidence interval [CI]) for surgery compared with definitive RT was 0.465 (0.354-0.610, P < 0.001). The aHR (95% CI) for age >80 years compared with age 70-80 years was 2.370 (1.720, 3.265, P < 0.001). The aHR (95% CI) for T2N0M0 compared with T1N0M0 was 1.752 (1.321-2.32, P < 0.001). The aHR (95% CI) for Charlson Comorbidity Index (CCI) ≥ 2 compared with CCI = 0 was 1.264 (1.137-1.738, P = 0.011). After stratified analysis, the aHRs for surgery compared with definitive RT were 0.484 (0.352-0.665, P < 0.001) and 0.411 (0.232-0.728, P = 0.002) among old and very old patients with E-OCSCC, respectively. CONCLUSIONS Surgery may be more beneficial than definitive RT in selected elderly patients with E-OCSCC.
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Affiliation(s)
- Wen-Chi Liu
- Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan; Department of Cancer Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsueh-Erh Liu
- Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Wei Kao
- Graduate Institute of Business Administration, Fu Jen Catholic University, Taipei, Taiwan
| | - Lei Qin
- School of Statistics, University of International Business and Economics, Beijing, China
| | - Kuan-Chou Lin
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chih-Yuan Fang
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Lo-Lin Tsai
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ben-Chang Shia
- Research Center of Big Data, College of Management, Taipei Medical University, Taipei, Taiwan; College of Management, Taipei Medical University, Taipei, Taiwan; Executive Master Program of Business Administration in Biotechnology, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Szu-Yuan Wu
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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Gold PA, Garbarino LJ, Anis HK, Neufeld EV, Sodhi N, Danoff JR, Boraiah S, Rasquinha VJ, Mont MA. The Cumulative Effect of Substance Abuse Disorders and Depression on Postoperative Complications After Primary Total Knee Arthroplasty. J Arthroplasty 2020; 35:S151-S157. [PMID: 32061474 DOI: 10.1016/j.arth.2020.01.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/06/2020] [Accepted: 01/14/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Substance abuse disorder (SUD), alcohol abuse disorder (AUD), and depression have been identified as independent risk factors for complications after total knee arthroplasty (TKA). However, these mental health disorders are highly co-associated, and their cumulative effect on postoperative complications have not been investigated. Therefore, this study aimed to determine if patients who have more than one mental health disorder (SUD, AUD, or depression) were at an increased risk for postoperative complications following TKA. METHODS A total of 11,403 TKA patients were identified from a prospectively collected institutional database between January 1, 2017 and April 1, 2019. Patients who had depression, SUD, and AUD were separated into 7 mental health subgroups including each of these diagnoses alone and their combined permeations. Patient demographics, body mass indices, medical comorbidities, and 15 postoperative complications were collected. Univariate analyses were performed using independent Student's t-tests. Multivariate analyses were then performed to identify odds ratios (ORs) for mental health disorders subgroups associated with complications. RESULTS We found a total of 2073 (18%) patients diagnosed with either SUD (4%), AUD (0.6%), or depression (12%). Univariate analyses showed that depression was associated with mechanical failures (P < .001). SUD was associated with periprosthetic joint infection (PJI) (P < .001), wound complications (P = .022), and aseptic loosening (P = .007). AUD was associated with PJI (P < .001) and deep vein thromboses (P = .003). Multivariate analyses found that AUD (OR: 19.419, P < .001) and SUD (OR:3.693, P = .010) were independent risk factors for PJI. Compared with SUD alone, patients with depression plus SUD were found to have a 4-fold (OR: 13.639, P < .001) and 2-fold (OR:4.401, P = .021) increased risk for PJI and cellulitis, respectively. CONCLUSIONS Patients who had depression, SUD, or AUD were at increased risk for postoperative complications following primary TKA. When patients have more than one mental health diagnosis, their risk for complications was amplified. The results of this study can help identify those patients who are at greater risk of postoperative complications to enable improved preoperative optimization and patient education.
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Affiliation(s)
- Peter A Gold
- Department of Orthopedic Surgery, Long Island Jewish Medical Center, New Hyde Park, NY
| | - Luke J Garbarino
- Department of Orthopedic Surgery, Long Island Jewish Medical Center, New Hyde Park, NY
| | - Hiba K Anis
- Department of Orthopedic Surgery, The Cleveland Clinic, Cleveland, OH
| | - Eric V Neufeld
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Nipun Sodhi
- Department of Orthopedic Surgery, Long Island Jewish Medical Center, New Hyde Park, NY
| | - Jonathan R Danoff
- Department of Orthopedic Surgery, North Shore University Hospital, Manhasset, NY
| | - Sreevathsa Boraiah
- Department of Orthopedic Surgery, North Shore University Hospital, Manhasset, NY
| | - Vijay J Rasquinha
- Department of Orthopedic Surgery, Long Island Jewish Medical Center, New Hyde Park, NY
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY
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Snowden C, Lynch E, Avery L, Haighton C, Howel D, Mamasoula V, Gilvarry E, McColl E, Prentis J, Gerrand C, Steel A, Goudie N, Howe N, Kaner E. Preoperative behavioural intervention to reduce drinking before elective orthopaedic surgery: the PRE-OP BIRDS feasibility RCT. Health Technol Assess 2020; 24:1-176. [PMID: 32131964 DOI: 10.3310/hta24120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Heavy alcohol consumption is associated with an increased risk of postoperative complications and extended hospital stay. Alcohol consumption therefore represents a modifiable risk factor for surgical outcomes. Brief behavioural interventions have been shown to be effective in reducing alcohol consumption among increased risk and risky drinkers in other health-care settings and may offer a method of addressing preoperative alcohol consumption. OBJECTIVES To investigate the feasibility of introducing a screening process to assess adult preoperative drinking levels and to deliver a brief behavioural intervention adapted for the target population group. To conduct a two-arm (brief behavioural intervention plus standard preoperative care vs. standard preoperative care alone), multicentre, pilot randomised controlled trial to assess the feasibility of proceeding to a definitive trial. To conduct focus groups and a national web-based survey to establish current treatment as usual for alcohol screening and intervention in preoperative assessment. DESIGN A single-centre, qualitative, feasibility study was followed by a multicentre, two-arm (brief behavioural intervention vs. treatment as usual), individually randomised controlled pilot trial with an embedded qualitative process evaluation. Focus groups and a quantitative survey were employed to characterise treatment as usual in preoperative assessment. SETTING The feasibility study took place at a secondary care hospital in the north-east of England. The pilot trial was conducted at three large secondary care centres in the north-east of England. PARTICIPANTS Nine health-care professionals and 15 patients (mean age 70.5 years, 86.7% male) participated in the feasibility study. Eleven health-care professionals and 68 patients (mean age 66.2 years, 80.9% male) participated in the pilot randomised trial. An additional 19 health-care professionals were recruited to one of three focus groups, while 62 completed an electronic survey to characterise treatment as usual. INTERVENTIONS The brief behavioural intervention comprised two sessions. The first session, delivered face to face in the preoperative assessment clinic, involved 5 minutes of structured brief advice followed by 15-20 minutes of behaviour change counselling, including goal-setting, problem-solving and identifying sources of social support. The second session, an optional booster, took place approximately 1 week before surgery and offered the opportunity to assess progress and boost self-efficacy. MAIN OUTCOME MEASURES Feasibility was assessed using rates of eligibility, recruitment and retention. The progression criteria for a definitive trial were recruitment of ≥ 40% of eligible patients and retention of ≥ 70% at 6-month follow-up. Acceptability was assessed using themes identified in qualitative data. RESULTS The initial recruitment of eligible patients was low but improved with the optimisation of recruitment processes. The recruitment of eligible participants to the pilot trial (34%) fell short of the progression criteria but was mitigated by very high retention (96%) at the 6-month follow-up. Multimethod analyses identified the methods as acceptable to the patients and professionals involved and offers recommendations of ways to further improve recruitment. CONCLUSIONS The evidence supports the feasibility of a definitive trial to assess the effectiveness of brief behavioural intervention in reducing preoperative alcohol consumption and for secondary outcomes of surgical complications if recommendations for further improvements are adopted. TRIAL REGISTRATION Current Controlled Trials ISRCTN36257982. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 12. See the National Institute for Health Research Journals Library website for further project information.
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Affiliation(s)
- Christopher Snowden
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Ellen Lynch
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Leah Avery
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Catherine Haighton
- Department of Social Work, Education & Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Denise Howel
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Valentina Mamasoula
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Eilish Gilvarry
- Newcastle Addictions Service, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Elaine McColl
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - James Prentis
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | | | - Alison Steel
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola Goudie
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola Howe
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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Raj AS, Cobain C, Abbott TE, Cron N. Abstinence from alcohol consumption and exercise capacity: A pre and post intervention cohort study. J Perioper Pract 2020; 31:89-95. [PMID: 31916909 DOI: 10.1177/1750458919889879] [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: 11/16/2022]
Abstract
The benefits or harm associated with moderate levels of alcohol consumption on cardiorespiratory fitness are unclear. We hypothesised that in moderate drinkers, four weeks of abstinence could improve cardiorespiratory fitness. This was a single centre, prospective, pre and post intervention, experimental cohort study. Participants were recruited from healthy volunteers among hospital staff, who were non-smokers, over 25 years of age and regularly consumed ≥3 units of alcohol a day, ≥4 times a week for > 1 month. Cardiopulmonary exercise test was used to provide objective, quantifiable and reproducible data. In all, 30 participated, and data were analysed for 22 participants. Mean (SD) peak oxygen consumption and oxygen consumption at anaerobic threshold were similar before and after alcohol abstinence: 37.55 (10.89) and 39.66 (11.48) (P = 0.21) and 18.52 (5.43) and 16.82 (5.19) ml/kg/min (P = 0.1), respectively. It is concluded that this preliminary study did not establish a correlation between four weeks alcohol abstinence and cardiopulmonary fitness as measured by cardiopulmonary exercise test, among healthy volunteers self-reporting moderate alcohol consumption.
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Affiliation(s)
- Ashok S Raj
- Anaesthesia and Intensive Care Medicine, Croydon University Hospital, Croydon, UK
| | - Charlotte Cobain
- Anaesthesia and Intensive Care Medicine, Epsom and St Helier University Hospital NHS Trust, Epsom, UK
| | - Tom Ef Abbott
- William Harvey Research Institute, Critical Care and Perioperative Medicine Research Group, The Royal London Hospital, London, UK
| | - Nicholas Cron
- Department of Statistics, London School of Economics, London, UK
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14
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Shah A, Memon M, Kay J, Wood TJ, Tushinski DM, Khanna V. Preoperative Patient Factors Affecting Length of Stay following Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2019; 34:2124-2165.e1. [PMID: 31182407 DOI: 10.1016/j.arth.2019.04.048] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/12/2019] [Accepted: 04/23/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) yields substantial improvements in quality of life for patients with severe osteoarthritis. Previous research has shown that TKA outcomes are inferior in patients with certain demographic and clinical factors. Length of stay (LOS) following TKA is a major component of costs incurred by healthcare providers. It is hypothesized that patient-related factors may influence LOS following TKA. The purpose of this systematic review and meta-analysis is to investigate these factors. METHODS Three databases (PubMed, Embase, and OVID Medline) were searched using variants of the terms "total knee arthroplasty" and "length of stay". Studies were screened and data abstracted in duplicate. The primary outcome was the effect of prognostic variables on LOS following TKA. Meta-analysis was performed using the Review Manager (RevMan) software (version 5.3. Copenhagen: The Nordic Cochrane Center, The Cochrane Collaboration, 2014). RESULTS A total of 68 studies met all inclusion criteria for this review. These studies comprised 21,494,459 patients undergoing TKA with mean age 66.82 years (range, 15-95 years) and 63.8% (12,165,160 of 19,060,572 reported) females. The mean MINORS score was 7, suggesting that studies had a low quality of evidence. Mean LOS following TKA has steadily decreased over the past 4 decades, partially because of the implementation of fast-track programs. Demographic factors associated with increased LOS were age >70 years (mean difference [MD] = 0.81; 95% confidence interval [CI] = 0.38-1.24), female gender (MD = 0.32; 95% CI = 0.29-0.48), body mass index >30 (MD = 0.09; 95% CI = 0.01-0.16), and non-White race (MD = 0.20; 95% CI = 0.10-0.29). Clinical factors associated with increased LOS were American Society of Anesthesiologists score 3-4 vs 1-2 (MD = 1.12; 95% CI = 0.58 to 1.66), Charlson Comorbidity Index > 0 vs 0 (MD = 0.77; 95% CI = 0.32 to 1.22), and preoperative hemoglobin < 130 g/L (MD = 0.66; 95% CI = 0.34 to 0.98). CONCLUSION This systematic review and meta-analysis showed that increased age, female gender, body mass index ≥ 30, non-White race, American Society of Anesthesiologists > 2, Charlson Comorbidity Index > 0, and preoperative hemoglobin < 130 g/L were predictors of increased LOS. Mean LOS has steadily decreased over the past decades with the implementation of perioperative "fast-track" programs. Future research should investigate the benefits of preoperative risk factor modification on LOS, in addition to novel surgical approaches, anesthetic adjuvants, and physiotherapy modifications. LEVEL OF EVIDENCE IV, systematic review, and meta-analysis of level III and IV evidence.
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Affiliation(s)
- Ajay Shah
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Muzammil Memon
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey Kay
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Thomas J Wood
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Daniel M Tushinski
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Vickas Khanna
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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15
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Antonelli B, Chen AF. Reducing the risk of infection after total joint arthroplasty: preoperative optimization. ARTHROPLASTY 2019; 1:4. [PMID: 35240760 PMCID: PMC8787890 DOI: 10.1186/s42836-019-0003-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/20/2019] [Indexed: 12/13/2022] Open
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16
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Cizmic Z, Feng JE, Huang R, Iorio R, Komnos G, Kunutsor SK, Metwaly RG, Saleh UH, Sheth N, Sloan M. Hip and Knee Section, Prevention, Host Related: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S255-S270. [PMID: 30348549 DOI: 10.1016/j.arth.2018.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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17
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Zainul-Abidin S, Amanatullah DF, Anderson MB, Austin M, Barretto JM, Battenberg A, Bedard NA, Bell K, Blevins K, Callaghan JJ, Cao L, Certain L, Chang Y, Chen JP, Cizmic Z, Coward J, DeMik DE, Diaz-Borjon E, Enayatollahi MA, Feng JE, Fernando N, Gililland JM, Goodman S, Goodman S, Greenky M, Hwang K, Iorio R, Karas V, Khan R, Kheir M, Klement MR, Kunutsor SK, Limas R, Morales Maldonado RA, Manrique J, Matar WY, Mokete L, Nung N, Pelt CE, Pietrzak JRT, Premkumar A, Rondon A, Sanchez M, Novaes de Santana C, Sheth N, Singh J, Springer BD, Tay KS, Varin D, Wellman S, Wu L, Xu C, Yates AJ. General Assembly, Prevention, Host Related General: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S13-S35. [PMID: 30360983 DOI: 10.1016/j.arth.2018.09.050] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Egholm JWM, Pedersen B, Møller AM, Adami J, Juhl CB, Tønnesen H. Perioperative alcohol cessation intervention for postoperative complications. Cochrane Database Syst Rev 2018; 11:CD008343. [PMID: 30408162 PMCID: PMC6517044 DOI: 10.1002/14651858.cd008343.pub3] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Risky consumption of alcohol is a global problem. More than 3.3 million deaths annually are associated with risky use of alcohol, and global alcohol consumption continues to increase. People who have high alcohol consumption often require planned and emergency surgical procedures.Risky drinking is associated with increased postoperative complications such as infections, cardiopulmonary complications, and bleeding episodes. Alcohol causes disorders of the liver, pancreas, and nervous system. Stopping consumption of alcohol can normalize these organ systems to some degree and may reduce the occurrence of complications after surgery.This review was first published in 2012 and was updated in 2018. OBJECTIVES To assess the effects of perioperative alcohol cessation interventions on rates of postoperative complications and alcohol consumption. SEARCH METHODS We searched the following databases up until 21 September 2018: Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; MEDLINE; Embase; CINAHL via EBSCOhost; and two trials registers. We scanned the reference lists and citations of included trials and any identified relevant systematic reviews for further references to additional trials. When necessary, we contacted trial authors to ask for additional information. SELECTION CRITERIA We included all randomized controlled trials (RCTs) that evaluated the effects of perioperative alcohol cessation interventions on postoperative complications and alcohol consumption. We included participants with risky consumption of alcohol who were undergoing all types of elective or acute surgical procedures under general or regional anaesthesia or sedation, who were offered a perioperative alcohol cessation intervention or no intervention.We defined 'risky drinking' as alcohol consumption equivalent to more than 3 alcoholic units (AU)/d or 21 AU/week (with 1 AU containing 12 grams of ethanol) with or without symptoms of alcohol abuse or dependency. This corresponds to the amount of alcohol associated with increased postoperative complication rates in most clinical studies. DATA COLLECTION AND ANALYSIS We used guidance provided in the Cochrane Handbook for Systematic Reviews of Interventions. We presented main outcomes as dichotomous variables in a meta-analysis. When data were available, we conducted subgroup and sensitivity analyses to explore the risk of bias. Primary outcome measures were postoperative complications and in-hospital and 30-day mortality. Secondary outcomes were successful quitting at the end of the programme, postoperative alcohol use, and length of hospital stay. We assessed the quality of evidence using the GRADE approach. MAIN RESULTS We included in this updated review one new study (70 participants), resulting in a total of three RCTs (140 participants who drank 3 to 40 AU/d). All three studies were of moderate to good quality. All studies evaluated the effects of intensive alcohol cessation interventions, including pharmacological strategies for alcohol withdrawal symptoms, patient education, and relapse prophylaxis. We identified one ongoing study.Overall, 53 of the 122 participants from three studies who underwent surgery developed any type of postoperative complication that required treatment. Of 61 participants in the intervention groups, 20 had complications, compared with 33 of 61 participants in the control groups (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.40 to 0.96). Results show differences between the three clinical studies regarding outcome measurement and intensity of the interventions. However, all alcohol cessation programmes were intensive and included pharmacological therapy. The overall quality of evidence for this outcome is moderate.In-hospital and 30-day postoperative mortality rates were low in the three studies. Researchers reported one death among 61 participants in the intervention groups, and three deaths among 61 participants in the control groups (RR 0.47, 95% CI 0.07 to 2.96). The quality of evidence for this outcome is low.Investigators describe more successful quitters at the end of the intervention programme than among controls. Forty-one out of 70 participants in the intervention groups successfully quit drinking compared with only five out of 70 participants in the control groups (RR 8.22, 95% CI 1.67 to 40.44). The quality of evidence for this outcome is moderate.All three studies reported postoperative alcohol consumption (grams of alcohol/week) at the end of the programme as median and range values; therefore it was not possible to estimate the mean and the standard deviation (SD). We performed no meta-analysis. All three studies reported length of stay, and none of these studies described a significant difference in length of stay. Data were insufficient for review authors to perform a meta-analysis. No studies reported on the prevalence of participants without risky drinking in the longer term. AUTHORS' CONCLUSIONS This systematic review assessed the efficacy of perioperative alcohol cessation interventions for postoperative complications and alcohol consumption. All three studies showed a significant reduction in the number of participants who quit drinking alcohol during the intervention period. Intensive alcohol cessation interventions offered for four to eight weeks to participants undergoing all types of surgical procedures to achieve complete alcohol cessation before surgery probably reduced the number of postoperative complications. Data were insufficient for review authors to assess their effects on postoperative mortality. No studies reported an effect on length of stay, and no studies addressed the prevalence of risky drinking in the longer term.Included studies were few and reported small sample sizes; therefore one should be careful about drawing firm conclusions based on these study results. All three studies were conducted in Denmark, and most participants were men. The included participants may represent a selective group, as they could have been more motivated and/or more interested in participating in clinical research or otherwise different, and effects may have been overestimated for both intervention and control groups in these studies. Trial results indicate that these studies are difficult to perform, that strong research competencies are necessary for future studies, and that further evaluation of perioperative alcohol cessation interventions in high-quality randomized controlled trials is needed. Once published and assessed, the one 'ongoing' study identified may alter the conclusions of this review.
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Affiliation(s)
- Julie WM Egholm
- Hospital of Southern Jutland, University of Southern DenmarkOrthopaedic DepartmentAabenraaDenmark6200
- Bispebjerg and Frederiksberg Hospitals, University of CopenhagenWHO‐CC, Clinical Health Promotion CentreCopenhagenDenmark
| | - Bolette Pedersen
- Bispebjerg and Frederiksberg Hospitals, University of CopenhagenWHO‐CC, Clinical Health Promotion CentreCopenhagenDenmark
- Lund UniversityDepartment of Health SciencesLundSweden
| | - Ann Merete Møller
- Herlev and Gentofte Hospital, University of CopenhagenCochrane Anaesthesia, Critical and Emergency Care GroupHerlev RingvejHerlevDenmark2730
| | - Johanna Adami
- Sophiahemmet UniversityLindstedtsvägen 8StockholmSweden
| | - Carsten B Juhl
- University of Southern DenmarkSEARCH (Research group for synthesis of evidence and research), Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical BiomechanicsCampusvej 55Odense MDenmark5230
| | - Hanne Tønnesen
- Hospital of Southern Jutland, University of Southern DenmarkOrthopaedic DepartmentAabenraaDenmark6200
- Bispebjerg and Frederiksberg Hospitals, University of CopenhagenWHO‐CC, Clinical Health Promotion CentreCopenhagenDenmark
- Lund UniversityDepartment of Health SciencesLundSweden
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Rhon DI, Greenlee TA, Marchant BG, Sissel CD, Cook CE. Comorbidities in the first 2 years after arthroscopic hip surgery: substantial increases in mental health disorders, chronic pain, substance abuse and cardiometabolic conditions. Br J Sports Med 2018; 53:547-553. [DOI: 10.1136/bjsports-2018-099294] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2018] [Indexed: 02/05/2023]
Abstract
ObjectivesWe aimed to identify the rate of seven comorbidities (mental health disorders, chronic pain, substance abuse disorders, cardiovascular disorders, metabolic syndrome, systemic arthropathy and sleep disorders) that occurred within 2 years after hip arthroscopy.MethodsData from individuals (ages 18–50 years) undergoing arthroscopic hip surgery between 2004 and 2013 were collected from the Military Health System (MHS) Data Repository (MDR). The MDR captures all healthcare encounters in all settings and locations for individuals within the MHS. Person-level data over 36 months were pulled and aggregated. Seven comorbidities related to poor outcomes from musculoskeletal disorders (mental health disorders, chronic pain, substance abuse disorders, cardiovascular disorders, metabolic syndrome, systemic arthropathy and sleep disorders) were examined 12 months prior and 24 months after surgery. Changes in frequencies were calculated as were differences in proportions between presurgery and postsurgery.Results1870 subjects were identified (mean age 32.24 years; 55.5% men) and analysed. There were statistically significant increases (p<0.001) proportionally for all comorbidities after surgery. Relative to baseline, cases of mental health disorders rose 84%, chronic pain diagnoses increased 166%, substance abuse disorders rose 57%, cardiovascular disorders rose by 71%, metabolic syndrome cases rose 85.9%, systemic arthropathy rose 132% and sleep disorders rose 111%.ConclusionsMajor (potentially ‘hidden’) clinical comorbidities increased substantially after elective arthroscopic hip surgery when compared with preoperative status. These comorbidities appear to have been overlooked in major studies evaluating the benefits and risks of arthroscopic hip surgery.Level of evidencePrognostic, level III.
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20
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Snowden C, Lynch E, Avery L, Gerrand C, Gilvarry E, Goudie N, Haighton C, Hall L, Howe N, Howel D, McColl E, Prentis J, Stamp E, Kaner E. Preoperative Behavioural Intervention versus standard care to Reduce Drinking before elective orthopaedic Surgery (PRE-OP BIRDS): protocol for a multicentre pilot randomised controlled trial. Pilot Feasibility Stud 2018; 4:140. [PMID: 30128165 PMCID: PMC6094560 DOI: 10.1186/s40814-018-0330-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 08/05/2018] [Indexed: 12/19/2022] Open
Abstract
Background Evidence suggests that increased preoperative alcohol consumption increases the risk of postoperative complications; therefore, a reduction or cessation in alcohol intake before surgery may reduce perioperative risk. Preoperative assessment presents an opportunity to intervene to optimise patients for surgery. This multicentre, two-arm, parallel group, individually randomised controlled trial will investigate whether a definitive trial of a brief behavioural intervention aimed at reducing preoperative alcohol consumption is feasible and acceptable to healthcare professionals responsible for its delivery and the preoperative elective orthopaedic patient population. Methods Screening will be conducted by trained healthcare professionals at three hospitals in the North East of England. Eligible patients (those aged 18 or over, listed for elective hip or knee arthroplasty surgery and scoring 5 or more or reporting consumption of six or more units on a single occasion at least weekly on the alcohol screening tool) who enrol in the trial will be randomised on a one-to-one non-blinded basis to either treatment as usual or brief behavioural intervention delivered in the pre-assessment clinic. Patients will be followed up 1–2 days pre-surgery, 1–5 days post-surgery (as an in-patient), 6 weeks post-surgery, and 6 months post intervention. Feasibility will be assessed through rates of screening, eligibility, recruitment, and retention to 6-month follow-up. An embedded qualitative study will explore the acceptability of study methods to patients and staff. Discussion This pilot randomised controlled trial will establish the feasibility and acceptability of trial procedures reducing uncertainties ahead of a definitive randomised controlled trial to establish the effectiveness of brief behavioural intervention to reduce alcohol consumption in the preoperative period and the potential impact on perioperative complications. Trial registration Reference number ISRCTN36257982
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Affiliation(s)
- Christopher Snowden
- 1The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, Newcastle upon Tyne, NE7 7DN UK.,3Institute of Cellular Medicine, 4th Floor, William Leech Building, Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH UK
| | - Ellen Lynch
- 2Institute of Health & Society, Newcastle University, Baddiley-Clark, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Leah Avery
- 3Institute of Cellular Medicine, 4th Floor, William Leech Building, Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH UK
| | - Craig Gerrand
- 1The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, Newcastle upon Tyne, NE7 7DN UK
| | - Eilish Gilvarry
- 4Newcastle Addictions Service, Northumberland Tyne and Wear NHS Foundation Trust, Plummer Court, Carliol Square, Newcastle upon Tyne, NE1 6UR UK
| | - Nicola Goudie
- 5Newcastle Clinical Trials Unit, Newcastle University, 1-4 Claremont Terrace, Newcastle upon Tyne, NE2 4AE UK
| | - Catherine Haighton
- 6Department of Social Work, Education & Community Wellbeing, Northumbria University, Room B125, Coach Lane Campus West, Newcastle upon Tyne, NE7 7XA UK
| | - Lesley Hall
- 5Newcastle Clinical Trials Unit, Newcastle University, 1-4 Claremont Terrace, Newcastle upon Tyne, NE2 4AE UK
| | - Nicola Howe
- 5Newcastle Clinical Trials Unit, Newcastle University, 1-4 Claremont Terrace, Newcastle upon Tyne, NE2 4AE UK
| | - Denise Howel
- 2Institute of Health & Society, Newcastle University, Baddiley-Clark, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Elaine McColl
- 2Institute of Health & Society, Newcastle University, Baddiley-Clark, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - James Prentis
- 1The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, Newcastle upon Tyne, NE7 7DN UK
| | - Elaine Stamp
- 2Institute of Health & Society, Newcastle University, Baddiley-Clark, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Eileen Kaner
- 2Institute of Health & Society, Newcastle University, Baddiley-Clark, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
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