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Sun JJ, Aryeetey L, Jones H, Huerta S, Mounasamy V, Sambandam S. The impact of crohn's disease on patients undergoing total knee arthroplasty. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05558-1. [PMID: 39259313 DOI: 10.1007/s00402-024-05558-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 09/05/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND The knee joint remains the most affected joint in extra-intestinal manifestations of Crohn's disease (CD). Given the increasing prevalence of CD and overall demand for total knee arthroplasty (TKA), it is likely that an increasing number of patients with CD will require TKA. The purpose of this study was to assess the inpatient postoperative complication in patients with CD undergoing TKA. MATERIALS AND METHODS We queried the Nationwide Inpatient Sample (NIS) database between the years of 2016 to 2019, including a total of 558,371 patients who underwent primary TKA. Among these, 1461 were in the CD group and 556,910 were in the non-CD group (controls). Data pertaining to demographics, length of stay (LOS), total healthcare cost, mortality, and in-hospital complications (blood loss anemia, blood transfusion, periprosthetic infection, periprosthetic dislocation, periprosthetic mechanical complication, acute renal failure, myocardial infarction, pneumonia, pulmonary embolism, deep vein thrombosis, superficial/deep surgical site infection, and wound dehiscence) were compared between the two groups. RESULTS Patients diagnosed with CD had higher postoperative complications such as blood loss anemia (OR: 1.22, 95% CI: 1.07-1.39, p = 0.004), periprosthetic infection (OR: 1.80, 95% CI: 1.23-2.63, p = 0.006), and the need for blood transfusion (OR: 1.447, 95% CI: 1.01-2.06, p = 0.044) in comparison to the control group. In-hospital mortality and acute renal failure were similar in both groups. The CD group had a significantly prolonged LOS (2.54 vs. 2.35 days, p < 0.001). No statistically significant difference was noted concerning in-hospital charges between the two groups. CONCLUSIONS CD patients undergoing TKA experienced increased LOS and postoperative complications. However, these complications were minor and did not affect total hospital cost. Further prospective cohort studies could build upon the findings described to continue to maximize outcomes in CD patients undergoing TKA, which might extend to other cohorts.
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Affiliation(s)
- Joshua J Sun
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
| | - Lemuelson Aryeetey
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Hunter Jones
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Sergio Huerta
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Varatharaj Mounasamy
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Senthil Sambandam
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
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Adalbert JR, Constantinescu DS, Orton KS, D'Apuzzo MR. Miscoding in the Nationwide Inpatient Sample Database Raises Questions About Validity for Arthroplasty Research. J Arthroplasty 2024; 39:S104-S109. [PMID: 38237876 DOI: 10.1016/j.arth.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/22/2023] [Accepted: 01/09/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND The use of administrative databases in arthroplasty research has increased over the past decade. The Nationwide Inpatient Sample (NIS) is one of the first and most frequently used. Despite many published articles using this dataset, there exists no standardization resource accounting for the potential of biased results. The purpose of our study was to assess the amount of discordant data between clinically relevant variables and propose a standard for using this database in primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS An initial set of patients undergoing total joint arthroplasty were identified from the NIS between 2016 and 2019 using the International Classification of Diseases, 10th Revision, Procedure Coding System. All records with THA and TKA in any of the procedure variables (PR1-PR20) were included. A total of 63 relevant and consistent variables were selected for individual comparison including diagnosis-related group (1), elective (1), procedure codes (20), day of main procedure (1), and diagnosis codes (40). Descriptive statistics were used. A total of 3,562,819 patients were included in the initial set. RESULTS Using diagnosis-related groups, 5.3% were revision surgeries, 4.7% were not elective, 2.3% did not have THA or TKA as their primary procedure for hospitalization, and 2.9% of THA and 9.7% of TKA were bilateral. A total of 6.2% of the surgeries were done day(s) before or after admission, and 10.8% of THA and 6.3% of TKA were missing an orthopedic diagnosis for admission. Many had multiple orthopedic diagnoses for admission, 3.2% of THA and 0.7% of TKA. Overall miscoding was 23.3%. CONCLUSIONS Using the NIS without standardized data processing to study elective, unilateral, primary THA and TKA introduces major bias. A logical and stepwise approach to curate the data before analysis is proposed to improve research quality when using this database in hip and knee arthroplasty studies.
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Affiliation(s)
- Jenna R Adalbert
- Department of Orthopaedics Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - David S Constantinescu
- Department of Orthopaedics Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Kevin S Orton
- Department of Orthopaedics Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Michele R D'Apuzzo
- Department of Orthopaedics Surgery, University of Miami Miller School of Medicine, Miami, Florida
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DeKeyser G, Thorne T, Martin BI, Haller JM. Changing Epidemiology of Distal Femur Fractures: Increase in Geriatric Fractures and Rates of Distal Femur Replacement. J Am Acad Orthop Surg 2024:00124635-990000000-01083. [PMID: 39231280 DOI: 10.5435/jaaos-d-24-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/16/2024] [Indexed: 09/06/2024] Open
Abstract
INTRODUCTION Distal femur fractures (DFFs) are associated with high complication and mortality rates in the elderly. Using the National Inpatient Sample and Medicare data, we describe trends in the incidence of DFFs by fixation type and associated healthcare costs. METHODS Annual population rates and volume of inpatient DFFs were estimated using Poisson regression with the US Census as a denominator. We used Current Procedural Terminology codes in Medicare patients to determine episode-of-care cost by treatment, classified as intramedullary nail, open reduction and internal fixation, and distal femur arthroplasty (DFR). RESULTS The annual incidence of DFFs in the United States is approximately 27.4 per 100,000. Admission for DFFs increased from 2002 to 2020, with the highest volume and rate in those aged 85 years and older. DFF incidence increased (1.95×) from 142 per 1 million (95% CI: 140 to 144) in 2006 to 281 per 1 million (95% CI: 278-284) in 2019. From 2012 to 2019, the percentage of DFFs treated by intramedullary nail increased from 6.8% to 8.4%, open reduction and internal fixation decreased from 89.9% to 76.6%, and DFR increased from 3.3% to 14.9%. DFR cost was significantly greater than other treatment choices across all years for initial inpatient admission costs and 90-day episode-of-care costs (all P < 0.0001). CONCLUSION DFF volume has increased in the past 20 years, predominantly in elderly patients. Greater than 4.5× increase was observed in the proportion of geriatric DFFs treated with DFR during this study period. The total cost of DFR treatment was consistently greater than other surgical treatments.
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Affiliation(s)
- Graham DeKeyser
- From the Department of Orthopedic Surgery, Oregon Health and Science University, Portland, OR (DeKeyser), Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT (Thorne, Martin, and Haller)
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Terrell M, Dongarwar D, Rashid R, Hamisu S, Orengo I. Inpatient prevalence and factors associated with Merkel Cell Carcinoma inpatient hospitalization in the United States. Arch Dermatol Res 2024; 316:489. [PMID: 39066821 DOI: 10.1007/s00403-024-03222-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/16/2024] [Accepted: 07/06/2024] [Indexed: 07/30/2024]
Abstract
Merkel Cell Carcinoma is a rare and aggressive cutaneous carcinoma with a propensity for metastasis and death. Our study describes the prevalence, sociodemographics and inpatient mortality of Merkel Cell Carcinoma related hospitalizations in the United States from 2011 to 2020. We conducted an observational study using the Nationwide Inpatient Sample database, which captures a 20% sample of all hospitalizations in the United States. We utilized the International Classification of Disease Clinical Modification codes from the ninth and tenth revision to identify Merkel Cell Carcinoma and demographic factors. There was a total of 28,809 cases of Merkel Cell Carcinoma in the United States from 2011 to 2020. Merkel Cell Carcinoma was associated with white race (11.4 per 100,000) and disposition of death (26.8 per 100,000). It was most prevalent in the highest quartile income (12.5 per 100,000) and Medicare as primary payer (13.0 per 100,000). Hospitalization was lowest in nonwhite races, particularly NH-Blacks and NH-Others. Inpatient mortality was significantly associated with NH-Others (odds ratio 2.18, 95% confidence interval = 1.38-3.45) and self-pay patients (odds ratio = 2.93, 95% confidence interval 1.84-4.67).This study contributes to reported socio-demographic factors related to Merkel Cell Carcinomas and brings awareness to factors associated with increased hospitalization and inpatient mortality.
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Affiliation(s)
- Maci Terrell
- School of Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, USA.
| | - Deepa Dongarwar
- Department of Neurology, University of Texas Houston Health Science Center, Houston, TX, USA
| | | | - Salihu Hamisu
- School of Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, USA
| | - Ida Orengo
- School of Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, USA
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Beran A, Mohamed MFH, Vargas A, Aboursheid T, Aziz M, Hernaez R, Patidar KR, Nephew LD, Desai AP, Orman E, Chalasani N, Ghabril MS. Early Diagnostic Paracentesis Improves Outcomes of Hospitalized Patients With Cirrhosis and Ascites: A Systematic Review and Meta-Analysis. Am J Gastroenterol 2024:00000434-990000000-01206. [PMID: 38916217 DOI: 10.14309/ajg.0000000000002906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 06/06/2024] [Indexed: 06/26/2024]
Abstract
INTRODUCTION Diagnostic paracentesis is recommended for patients with cirrhosis admitted to the hospital, but adherence is suboptimal with unclear impact on clinical outcomes. The aim of this meta-analysis was to assess the outcomes of early vs delayed diagnostic paracentesis among hospitalized patients with cirrhosis and ascites. METHODS We searched multiple databases for studies comparing early vs delayed diagnostic paracentesis among hospitalized patients with cirrhosis and ascites. The pooled odds ratio (OR) and mean difference with confidence intervals (CIs) for proportional and continuous variables were calculated using the random-effects model. Early diagnostic paracentesis was defined as receiving diagnostic paracentesis within 12-24 hours of admission. The primary outcome was in-hospital mortality. Secondary outcomes were length of hospital stay, acute kidney injury, and 30-day readmission. RESULTS Seven studies (n = 78,744) (n = 45,533 early vs n = 33,211 delayed diagnostic paracentesis) were included. Early diagnostic paracentesis was associated with lower in-hospital mortality (OR 0.61, 95% CI 0.46-0.82, P = 0.001), length of hospital stay (mean difference -4.85 days; 95% CI -6.45 to -3.20; P < 0.001), and acute kidney injury (OR 0.62, 95% CI 0.42-0.92, P = 0.02) compared with delayed diagnostic paracentesis, with similar 30-day readmission (OR 1.11, 95% CI 0.52-2.39, P = 0.79). Subgroup analysis revealed consistent results for in-hospital mortality whether early diagnostic paracentesis performed within 12 hours (OR 0.51, 95% CI 0.32-0.79, P = 0.003, I2 = 0%) or within 24 hours of admission (OR 0.67, 95% CI 0.45-0.98, P = 0.04, I2 = 82%). Notably, the mortality OR was numerically lower when diagnostic paracentesis was performed within 12 hours, and the results were precise and homogenous ( I2 = 0%). DISCUSSION Findings from this meta-analysis suggest that early diagnostic paracentesis is associated with better patient outcomes. Early diagnostic paracentesis within 12 hours of admission may be associated with the greatest mortality benefit. Data from large-scale randomized trials are needed to validate our findings, especially if there is a greater mortality benefit for early diagnostic paracentesis within 12 hours.
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Affiliation(s)
- Azizullah Beran
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA
| | - Mouhand F H Mohamed
- Department of Internal Medicine, Warren Alpert Medical School Brown University, Providence, Rhode Island, USA
| | - Alejandra Vargas
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Tarek Aboursheid
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, Illinois, USA
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, Bon Secours Mercy Health, Toledo, Ohio, USA
| | - Ruben Hernaez
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Kavish R Patidar
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Lauren D Nephew
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA
| | - Archita P Desai
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA
| | - Eric Orman
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA
| | - Naga Chalasani
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA
| | - Marwan S Ghabril
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA
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Driesman A, Vyge O, Poate C, Quinlan N, Johnson RM, Dennis DA, Jennings JM. Rates of Registry Research Have Increased in Podium and Poster Presentations at the American Association of Hip and Knee Surgeons. Arthroplast Today 2024; 27:101413. [PMID: 38912096 PMCID: PMC11190495 DOI: 10.1016/j.artd.2024.101413] [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: 12/22/2023] [Revised: 03/27/2024] [Accepted: 04/28/2024] [Indexed: 06/25/2024] Open
Abstract
Background As state, regional, and national registries have rapidly expanded, the goal of this study is to assess the frequency of registry abstracts accepted for both podium and poster presentations at the American Association of Hip and Knee Surgeons between 2012 and 2022. Methods Final programs and poster e-collections were examined over the past 11 years. Two reviewers evaluated each abstract to determine if they utilized large datasets and the location of each registry. Studies were excluded if they used institutional registries. Reviewers also identified the most frequently utilized registries to determine how their use has fluctuated over this time frame. Results A total of 3354 abstracts were reviewed and included. Of those, 577 abstracts utilized data obtained from orthopaedic registries (17.2%): 450 of which were poster presentations (16.5% of total poster acceptances), and 127 were podium presentations (20.5% of accepted podiums). The National Surgical Quality Improvement Program (NSQIP) was the most frequent dataset utilized, with 118 (20.5%) abstracts. Of note, NSQIP's use peaked between 2018 and 2020 and has since slowly trended downward. On the other hand, use of both American Joint Replacement Registry (AJRR) and PearlDiver registry have drastically increased since 2019, with only 6 abstracts chosen in 2019 and 28 abstracts in 2022 (10 AJRR [3 podiums] and 18 PearlDiver [6 podiums]). The proportion of registry data has increased, with the registry abstracts peaking in 2022 as 24% of posters and 37% of podium utilized data from large registry data sets (P < .001). Conclusions There has been a significant increase in the number of studies utilizing registry data for both podium and poster presentations at the American Association of Hip and Knee Surgeons annual meeting. While NSQIP was the most utilized, its use has steadily declined while AJRR and PearlDiver use have increased over the past 3 years. Individuals should understand the strengths and weaknesses of each registry before making conclusions on study results. Level of Evidence Level IV.
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Affiliation(s)
| | | | | | | | | | - Douglas A. Dennis
- Colorado Joint Replacement, Denver, CO, USA
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA
- Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO, USA
- Department of Biomedical Engineering, University of Tennessee, Knoxville, TN, USA
| | - Jason M. Jennings
- Colorado Joint Replacement, Denver, CO, USA
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA
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Staats PS, Dorsi MJ, Reece DE, Strand NH, Poree L, Hagedorn JM. Percutaneous image-guided lumbar decompression and outpatient laminectomy for the treatment of lumbar spinal stenosis: a 2-year Medicare claims benchmark study. INTERVENTIONAL PAIN MEDICINE 2024; 3:100412. [PMID: 39238588 PMCID: PMC11373052 DOI: 10.1016/j.inpm.2024.100412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 09/07/2024]
Abstract
Background This prospective longitudinal study compares outcomes for Medicare beneficiaries receiving outpatient percutaneous image-guided lumbar decompression (PILD) using the mild® procedure to patients undergoing outpatient laminectomy. All patients were diagnosed with lumbar spinal stenosis (LSS) with neurogenic claudication (NC). Methods All medical claims for 100 % of Medicare beneficiaries were reviewed, with study subjects identified using Centers for Medicare and Medicaid Research Identifiable Files. Baseline data were extracted individually to allow for longitudinal analysis through two-year follow-up. The index procedure was defined as the first mild or outpatient laminectomy during the enrollment period. The rate of subsequent surgical procedures and incidence of harms were used as study outcomes. Results Cohorts included 2197 mild and 7416 laminectomy patients. mild patients were significantly older (76.7 years versus 73.4 years, respectively; p < 0.0001), and 57.4 % of mild were female, compared to 43.3 % of laminectomy (p < 0.0001). mild patients presented with significantly more baseline comorbidities compared to laminectomy patients (mean of 5.7 versus 4.8, respectively; p < 0.0001). Subsequent surgical procedure rate of 9.0 % for mild was significantly higher than 5.5 % for laminectomy (p < 0.0001). mild experienced harms at a significantly lower rate than laminectomy (1.9 % versus 5.8 %, respectively; p < 0.0001). The composite rate of subsequent surgical procedures and harms was similar between groups at 10.8 % for mild and 11.0 % for laminectomy. Conclusions mild can be considered a viable option for treatment of LSS with NC as evidenced by real-world data in this study. At two-years, mild patients experienced fewer harms and underwent more subsequent surgical procedures than laminectomy patients. The higher rate of subsequent surgical procedures for mild may be attributable to its position earlier in the LSS treatment algorithm. The overall rate of harms and subsequent surgical procedures was similar between groups, suggesting that mild should be considered as a treatment option, particularly for older patients with multiple comorbidities.
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Affiliation(s)
- Peter S Staats
- National Spine and Pain Centers, Atlantic Beach, FL, USA
| | - Michael J Dorsi
- UCLA, Westlake Village Primary & Specialty Care, 1250 La Venta Drive, Westlake Village, CA, 91361, USA
| | - David E Reece
- Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20889, USA
| | - Natalie H Strand
- Anesthesiology and Pain Medicine, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Lawrence Poree
- Department of Anesthesia and Perioperative Care, University of California at San Francisco, UCSF Pain Management Center, 2255 Post Street, San Francisco, CA, 94115, USA
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Lin YS, DeClercq JJ, Ayers GD, Gilmor RJ, Collett G, Jain NB. Incidence and Clinical Risk Factors of Post-Operative Complications following Primary Total Hip Arthroplasty: A 10-Year Population-Based Cohort Study. J Clin Med 2023; 13:160. [PMID: 38202167 PMCID: PMC10780046 DOI: 10.3390/jcm13010160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/19/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
Background: Total hip arthroplasty (THA) has become a growing treatment procedure for debilitating hip pathologies. Patients experienced post-operative complications and revision surgeries according to large THA registries. To fully understand the short-term and long-term post-operative outcomes following THA, the purpose of this study is to examine the incidence of post-operative complications following primary THA and to examine how this trend has changed over 10 years within community hospitals in the US using large databases. Methods: This study queried the State Inpatient Database (SID) for primary THA between 2006 and 2015. Individual patients were followed forward in time until the first instance of a post-operative complication. The multivariable logistic regression analyses were computed to examine which post-operative complications were independent predictors of pre-operative comorbidities. Results: Median age of patients was 67 years, and 56% of patients were female. Females with avascular necrosis (AVN) as an indication for THA had a 27% higher risk of complication. Females with osteoarthritis (OA) as an indication for THA had a 6% higher risk of complication. Post-operative complications occurred with higher frequencies in the first two months of THA and the highest risks of THA complications within the first 6 months. Conclusion: The most common indication is OA in elders with primary THA. Females and those of black ethnicity showed the greatest risks of THA complications. Data from our large study can be used to understand post-operative complications and readmissions after THA. Our study also provides data on risk factors associated with these complications.
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Affiliation(s)
- Yen-Sheng Lin
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX 75390, USA; (Y.-S.L.); (G.C.)
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Joshua J. DeClercq
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37212, USA (G.D.A.)
| | - Gregory D. Ayers
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37212, USA (G.D.A.)
| | | | - Garen Collett
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX 75390, USA; (Y.-S.L.); (G.C.)
| | - Nitin B. Jain
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX 75390, USA; (Y.-S.L.); (G.C.)
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37212, USA (G.D.A.)
- Department of Population & Data Sciences, University of Texas Southwestern, Dallas, TX 75390, USA
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Mao X, Liang C, Li X, Shi D, Yang Q, Xie H, Liang F, Cui Y. The impact of long-term aspirin use on the patients undergoing shoulder arthroplasty. J Orthop Surg Res 2023; 18:894. [PMID: 37993872 PMCID: PMC10666390 DOI: 10.1186/s13018-023-04374-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Although aspirin is increasingly utilized to reduce the event of severe perioperative complications, the effect of long-term aspirin use (L-AU) on perioperative complications in patients undergoing shoulder arthroplasty (SA) has not been well studied. The goal of the present study is to identify the influence of L-AU on perioperative complications in individuals undergoing SA. METHODS We selected data from the National Inpatient Sample database between 2010 and 2019, to identify adult patients with SA. Patients were subsequently categorized into L-AU and whole non-L-AU cohorts according to the presence of aspirin use. The demographic and comorbidity characteristics were matched using propensity score matching (PSM). The Pearson chi-square test, Wilcoxon rank test and logistic regression were utilized to assess the association of L-AU with perioperative complications. RESULTS From 2010 to 2019, a total of 162,418 SA patients satisfied the inclusion criteria, with 22,659 (13.95%) using aspirin on a long-term basis. The vast majority of the patients with pre-existing L-AU were aged 65-74 years, female, White and had Medicare insurance. L-AU before surgery was linked to increased risks of perioperative complications, such as blood transfusion (adjusted odds ratio [aOR]: 1.339), genitourinary disease (aOR: 1.349), acute renal failure (aOR: 1.292), acute myocardial infarction (aOR: 1.494), higher total charge (L-AU vs. the whole non-L-AU vs. matched non-L-AU: $66,727.15 vs. $59,697.08 vs. $59,926.32), and prolonged hospitalization stay (LOS) (aOR: 0.837). However, L-AU was considered a protective factor of acute cerebrovascular disease (aOR: 0.722) and stroke (aOR: 0.725). CONCLUSIONS Our study is based on the largest open-access all-payer inpatient database, revealing a noteworthy finding of aspirin's protective and adverse impact on different postoperative complications in the US population, such as acute cardiovascular disease, and stroke, etc. Further studies assessing the optimum preoperative aspirin duration and dosage to meet the best benefit quantity for patients with planned joint arthroplasties are suggested.
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Affiliation(s)
- Xiuhua Mao
- School of Health, Dongguan Polytechnic, Dongguan, 523000, Guangdong, China
| | - Chen Liang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Xiaoqin Li
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Danping Shi
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Qinfeng Yang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Hao Xie
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China.
| | - Fangguo Liang
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China.
| | - Yuhui Cui
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China.
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Swiontkowski MF, Callaghan JJ, Lewallen DG, Berry DJ. Large Database and Registry Research in Joint Arthroplasty and Orthopaedics. J Bone Joint Surg Am 2022; 104:1-3. [PMID: 36260035 DOI: 10.2106/jbjs.22.00932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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