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Kelly M, Huff T, Schabel K, Yoo J, Lieberman E, Kagan R. Active Amphetamine Abuse in Total Hip Arthroplasty Carries Increased Risk for Postoperative Surgical and Medical Complications. Arthroplast Today 2024; 27:101372. [PMID: 38654888 PMCID: PMC11035087 DOI: 10.1016/j.artd.2024.101372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/23/2024] [Accepted: 03/04/2024] [Indexed: 04/26/2024] Open
Abstract
Background The impact of amphetamine abuse on total hip arthroplasty (THA) outcomes has yet to be studied. As the rates of methamphetamine abuse continue to rise, understanding the risk profile of this population is imperative. This study aims to determine the risk of major surgical and medical complications for those with amphetamine abuse undergoing THA, with the hypothesis that amphetamine abuse carries increased risk. Methods A retrospective review was performed with all-claims data files of a large national database querying International Classification of Disease, tenth revision, procedure codes identifying 333,038 primary THA, and 1027 with active amphetamine abuse. Medical and surgical complications including infection, dislocation, implant failure, periprosthetic fracture, and revision, as well as length of hospital stay and 90-day readmission rate, were identified. Univariate analysis compared rates of dependent outcomes. To account for independent variables, logistic regression was performed using age, Charlson comorbidity index, sex, obesity, tobacco use, and alcohol use. The results were presented as odds ratios (OR) and P values with significance set at <0.05. Results Patients with active amphetamine abuse carried an increased risk of dislocation (OR 1.82, P ≤ .001), infection (OR 2.37, P ≤ .001), mechanical complications (OR 1.64, P ≤ .001), periprosthetic fracture (OR 1.53, P ≤ .05), revision (OR 1.70, P ≤ .001), 90-day readmission (OR 1.79, P ≤ .001), as well as medical complications (1.43, P = .02) compared to those without documented amphetamine abuse. Conclusions Patients with amphetamine abuse are at increased risk of postoperative surgical and medical complications following THA. We recommend consideration of these risks prior to primary THA in this patient population.
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Affiliation(s)
- Mackenzie Kelly
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Thomas Huff
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Kathryn Schabel
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Jung Yoo
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | | | - Ryland Kagan
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
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Magruder ML, Hidalgo Perea S, Gordon AM, Ng MK, Wong CHJ. The association of inflammatory bowel disease with postoperative complications, re-admissions and emergency department visits following primary total hip arthroplasty. Hip Int 2024; 34:350-355. [PMID: 38073282 DOI: 10.1177/11207000231216106] [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] [Indexed: 12/21/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is a systemic inflammatory disorder of the gut. Few studies have evaluated whether patients with a history of IBD have worse outcomes following primary total hip arthroplasty (THA). Therefore, the purpose of this study was to evaluate whether IBD is associated with increased: (1) medical complications; (2) readmissions; and (3) emergency department (ED) visits. METHODS Using a nationwide claims database, patients with IBD undergoing primary THA were identified and matched to a comparison group according to age, sex and the Charlson Comorbidity Index. Outcomes assessed included the development of 90-day medical complications, 90-day re-admissions and 90-day ED visit rates. A p-value <0.0001 was considered statistically significant. RESULTS Patients with IBD had a greater incidence and odds ratio of total medical complications (31.90% vs. 11.47%; OR 2.89; p < 0.0001) compared with matched controls. IBD patients had significantly higher incidence and odds ratio of developing acute kidney injury (5.46 vs. 1.46%; OR 3.92; p < 0.0001), cerebrovascular accident (1.32 vs. 0.35%; OR 3.79; p < 0.0001), pneumonia (4.02 vs. 1.30%; OR 3.19; p < 0.0001), respiratory failure (1.21 vs. 0.41%; OR 2.94; p < 0.0001), deep vein thrombosis (0.89% vs. 0.30%; OR 2.93; p < 0.0001), and other adverse events. IBD patients also had higher incidence and odds ratio of 90-day re-admissions (4.20% vs. 3.23%; OR 1.31; p < 0.0001) and ED visits (6.56% vs. 3.99%; OR 1.69; p < 0.0001). CONCLUSIONS This study found that patients with IBD are at increased risk of 90-day medical complications, re-admissions, and ED visits. Due to its systemic nature, surgeons operating on these patients should be aware of the disease's extra-intestinal manifestations, and the potential postoperative risks in IBD patients. Providers should use this investigation when educating patients on potential risks of elective THA.
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Affiliation(s)
- Matthew L Magruder
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Sofia Hidalgo Perea
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Adam M Gordon
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Mitchell K Ng
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Che Hang Jason Wong
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
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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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Di Martino A, Brunello M, Pederiva D, Schilardi F, Rossomando V, Cataldi P, D'Agostino C, Genco R, Faldini C. Fast Track Protocols and Early Rehabilitation after Surgery in Total Hip Arthroplasty: A Narrative Review. Clin Pract 2023; 13:569-582. [PMID: 37218803 DOI: 10.3390/clinpract13030052] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/14/2023] [Accepted: 04/19/2023] [Indexed: 05/24/2023] Open
Abstract
The Enhanced Recovery After Surgery (ERAS) or Fast Track is defined as a multi-disciplinary, peri- and post-operative approach finalized to reduce surgical stress and simplify post-operative recovery. It has been introduced more than 20 years ago by Khelet to improve outcomes in general surgery. Fast Track is adapted to the patient's condition and improves traditional rehabilitation methods using evidence-based practices. Fast Track programs have been introduced into total hip arthroplasty (THA) surgery, with a reduction in post-operative length of stay, shorter convalescence, and rapid functional recovery without increased morbidity and mortality. We have divided Fast Track into three cores: pre-, intra-, and post-operative. For the first, we analyzed the standards of patient selection, for the second the anesthesiologic and intraoperative protocols, for the third the possible complications and the appropriate postoperative management. This narrative review aims to present the current status of THA Fast Track surgery research, implementation, and perspectives for further improvements. By implementing the ERAS protocol in the THA setting, an increase in patient satisfaction can be obtained while retaining safety and improving clinical outcomes.
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Affiliation(s)
- Alberto Di Martino
- 1st Orthopedic and Traumatology Clinic, IRCCS Rizzoli Orthopedic Institute, Via G.C. Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136 Bologna, Italy
| | - Matteo Brunello
- 1st Orthopedic and Traumatology Clinic, IRCCS Rizzoli Orthopedic Institute, Via G.C. Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136 Bologna, Italy
| | - Davide Pederiva
- 1st Orthopedic and Traumatology Clinic, IRCCS Rizzoli Orthopedic Institute, Via G.C. Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136 Bologna, Italy
| | - Francesco Schilardi
- 1st Orthopedic and Traumatology Clinic, IRCCS Rizzoli Orthopedic Institute, Via G.C. Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136 Bologna, Italy
| | - Valentino Rossomando
- 1st Orthopedic and Traumatology Clinic, IRCCS Rizzoli Orthopedic Institute, Via G.C. Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136 Bologna, Italy
| | - Piergiorgio Cataldi
- 1st Orthopedic and Traumatology Clinic, IRCCS Rizzoli Orthopedic Institute, Via G.C. Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136 Bologna, Italy
| | - Claudio D'Agostino
- 1st Orthopedic and Traumatology Clinic, IRCCS Rizzoli Orthopedic Institute, Via G.C. Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136 Bologna, Italy
| | - Rossana Genco
- 1st Orthopedic and Traumatology Clinic, IRCCS Rizzoli Orthopedic Institute, Via G.C. Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136 Bologna, Italy
| | - Cesare Faldini
- 1st Orthopedic and Traumatology Clinic, IRCCS Rizzoli Orthopedic Institute, Via G.C. Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136 Bologna, Italy
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How to Create an Orthopaedic Arthroplasty Administrative Database Project: A Step-by-Step Guide Part I: Study Design. J Arthroplasty 2023; 38:407-413. [PMID: 36241012 DOI: 10.1016/j.arth.2022.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Use of clinical and administrative databases in orthopaedic surgery research has grown substantially in recent years. It is estimated that approximately 10% of all published lower extremity arthroplasty research have been database studies. The aim of this review is to serve as a guide on how to (1) design, (2) execute, and (3) publish an orthopaedic administrative database arthroplasty project. METHODS In part I, we discuss how to develop a research question and choose a database (when databases should/should not be used), detailing advantages/disadvantages of those most commonly used. To date, the most commonly published databases in orthopaedic research have been the National Inpatient Sample, Medicare, National Surgical Quality Improvement Program, and those provided by PearlDiver. General advantages of most database studies include accessibility, affordability compared to prospective research studies, ease of use, large sample sizes, and the ability to identify trends and aggregate outcomes of multiple health care systems/providers. RESULTS Disadvantages of most databases include their retrospective observational nature, limitations of procedural/billing coding, relatively short follow-up, limited ability to control for confounding variables, and lack of functional/patient-reported outcomes. CONCLUSION Although this study is not all-encompassing, we hope it will serve as a starting point for those interested in conducting and critically reviewing lower extremity arthroplasty database studies.
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Islam MS, Islam SS, Parvin S, Manjur M, Islam MR, Halder RC, Islam MS, Rahaman SK, Hoque M, Faruque MO, Haque AKMN. Current pathogens infecting open fracture tibia and their antibiotic susceptibility at a tertiary care teaching hospital in South East Asia. Infect Prev Pract 2022; 4:100205. [PMID: 35243317 PMCID: PMC8857645 DOI: 10.1016/j.infpip.2022.100205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/27/2022] [Indexed: 10/30/2022] Open
Abstract
Background Methods Results Conclusion
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