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Hendriks JRH, Baker RJ, de Groot TM, Lans A, Waryasz GR, Kerkhoffs GMMJ, Ashkani-Esfahani S, DiGiovanni CW, Guss D. The Influence of Patient Characteristics and Social Determinants of Health on Postoperative Complications Following Achilles Tendon Rupture. Foot Ankle Int 2024:10711007241250021. [PMID: 38798118 DOI: 10.1177/10711007241250021] [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] [Indexed: 05/29/2024]
Abstract
BACKGROUND The influence of social determinants of health (SDH) on postoperative complications has been investigated in several studies, although correlation with Achilles tendon rupture (ATR) repair remains uninvestigated. SDH encompasses several factors, including insurance status and area-based measurements, including the Area Deprivation Index (ADI) and Social Vulnerability Index (SVI), which ranks neighborhoods by social disadvantage. This study investigated the correlation between patient demographics, SDH, and complications following ATR repair. METHODS A retrospective cohort study was conducted on 521 patients who presented with acute ATR and met the inclusion criteria, including age ≥18 years, a minimum of 30-day follow-up, and repair within 28 days of rupture. We reviewed patient demographics, time to surgery (TTS), and postoperative complications, including venous thromboembolism (VTE), rerupture, surgical site infection (SSI), wound dehiscence, and sural nerve injury. SDH variables included race, smoking status, insurance status, level of education, ADI, and SVI. Univariate regression tested the correlation between complications and SDH indicators. Significant variables (P < .05) were included in a multivariate regression. RESULTS Sixty-eight complications occurred in 59 patients (11.3%). Multivariate regression showed that a higher ADI, that is, socially deprived individuals, was associated with lower rates of VTE (OR = 0.41, P = .04). Higher body mass index (BMI) was associated with rerupture (OR = 8.73, P < .01). Male patients had lower rates of wound dehiscence (OR = 0.31, P = .03) and VTE (OR = 0.32, P = .02) compared with women. Longer TTS correlated with sural nerve injuries (OR = 2.23, P < .01) and shorter TTS with reruptures (OR = 0.02, P = .02). CONCLUSION Some measures of SDH were associated with postoperative complications. Gender also may have an effect, with male sex associated with lower rates of wound dehiscence and VTE. BMI was associated with higher rates of reruptures and overall general complications. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Joris R H Hendriks
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Riley J Baker
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Tom M de Groot
- Department of Orthopaedic Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Amanda Lans
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory R Waryasz
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Foot and Ankle Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Newton-Wellesley Hospital, Boston, MA, USA
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Sports, Musculoskeletal Health, Amsterdam, the Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, the Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, the Netherlands
| | - Soheil Ashkani-Esfahani
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Foot and Ankle Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Newton-Wellesley Hospital, Boston, MA, USA
| | - Christopher W DiGiovanni
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Foot and Ankle Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Newton-Wellesley Hospital, Boston, MA, USA
| | - Daniel Guss
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Foot and Ankle Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Newton-Wellesley Hospital, Boston, MA, USA
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Wang F, Chemakin K, Shamamian P, Punn I, Campbell T, Ricci JA. Rectus Plication Does Not Increase Risk of Thromboembolic Events Following Abdominal Body Contouring: A Matched Case-Control Analysis. Aesthet Surg J 2022; 42:1435-1444. [PMID: 36074733 DOI: 10.1093/asj/sjac195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Rectus abdominis plication increases intra-abdominal pressure and lower-extremity venous stasis, which may increase the incidence of venous thromboembolism (VTE) events. OBJECTIVES The aim of this study was to investigate the potential association between VTE and rectus abdominis muscle plication during surgery. METHODS A retrospective review of all patients who underwent abdominal body contouring at the authors' institution between 2010 and 2020 was completed. Cases were those with postoperative VTEs and were matched to controls (1:4) via potential confounders. Variables collected include demographic data, operative details, comorbidities, and postoperative complications. Statistical analysis was performed with parametric, nonparametric, and multivariable regression modeling. RESULTS Overall, 1198 patients were included; 19 (1.59%) experienced a postoperative VTE and were matched to 76 controls. The overall cohort was 92.7% female with an average age of 44 years, an average Charlson Comorbidity Index of 1 point, and an average BMI of 30.1 kg/m2. History of cerebrovascular events (14.5% vs 36.8%, P = 0.026) differed significantly between cohorts, but no significant associations were noted in all other baseline demographics. Additionally, VTE cases were more likely to have received intraoperative blood transfusions (odds ratio = 8.4, P = 0.04). Bivariate analysis demonstrated cases were significantly more likely to experience concurrent complications, including delayed wound healing (0% vs 5.3%, P = 0.044), seroma formation (5.3% vs 21.1%, P = 0.027), and fat necrosis (0% vs 5.3%, P = 0.044). However, these findings were not significant in a multivariable regression model. Plication was not associated with VTE outcomes. CONCLUSIONS Rectus plication does not increase the risk of VTE. However, the odds of VTE are significantly increased in patients who received intraoperative blood products compared with those who did not. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Fei Wang
- Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Katherine Chemakin
- Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Peter Shamamian
- Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Isha Punn
- Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Tessa Campbell
- Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Joseph A Ricci
- Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
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Grits D, Hecht CJ, Acuña AJ, Burkhart RJ, Kamath AF. Have all races experienced reductions in complication rates following total hip arthroplasty? A NSQIP analysis between 2011 and 2019. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03385-x. [PMID: 36114874 DOI: 10.1007/s00590-022-03385-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/02/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Despite numerous articles in the orthopedic literature evaluating racial and ethnic disparities, inequalities in total joint arthroplasty outcomes remain. While the National Surgical Quality Improvement (NSQIP) database has been previously utilized to highlight these disparities, no previous analysis has evaluated how the rate of various perioperative complications has changed over recent years when segregating by patient race. Specifically, we evaluated if all races have experienced decreases in (1) medical complications, (2) wound complications, (3) venous thromboembolism (VTE), and (4) readmission/reoperation rates following total hip arthroplasty (THA) over recent years? METHODS Current Procedural Terminology (CPT) code 27,130 (total hip arthroplasty) was utilized to identify all THA procedures conducted between 2011 and 2019. Patients were segregated according to race and various demographics were collected. Linear regression was utilized to evaluate changes in each complication rate between 2011 and 2019. A multivariate regression was then conducted for each complication to evaluate whether race independently was associated with each outcome. RESULTS Our analysis included a total of 212,091 patients undergoing primary THA. This included 182,681 (85.76%) White, 19,267 (9.04%) Black, 5928 (2.78%) Hispanic, and 4215 (1.98%) Asian patients. We found that for urinary tract infection (UTI), acute renal failure, superficial SSI, and readmission rates, White patients experienced significant reductions between 2011 and 2019. However, this was not consistent across all races. Black race was associated with a significantly increased risk of acute renal failure (OR: 2.03, 95% CI: 1.17-3.34; p = 0.008), renal insufficiency (OR: 2.33, 95% CI: 1.62-3.28; p < 0.001), deep vein thrombosis (DVT) (OR: 1.34, 95% CI: 1.07-1.66; p = 0.01), and pulmonary embolism (PE) (OR: 1.76, 95% CIL: 1.36-2.24; p < 0.001). CONCLUSION Our analysis highlights specific complications for which further interventions are necessary to reduce inequalities across races. These include medical optimization, increased patient education, and continued efforts at understanding how social factors may impact-related care inequalities. Future study is needed to evaluate specific interventions that can be applied at the health systems level to ensure all patients undergoing THA receive the highest quality of care regardless of race.
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Affiliation(s)
- Daniel Grits
- Department of Orthopaedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Mail code A41, Cleveland, OH, 44195, USA
| | - Christian J Hecht
- Department of Orthopaedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Mail code A41, Cleveland, OH, 44195, USA
| | - Alexander J Acuña
- Department of Orthopaedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Mail code A41, Cleveland, OH, 44195, USA
| | - Robert J Burkhart
- Department of Orthopaedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Mail code A41, Cleveland, OH, 44195, USA
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Mail code A41, Cleveland, OH, 44195, USA.
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Zhao WG, Zhang WL, Zhang YZ. Characteristics of Deep Venous Thrombosis in Isolated Lower Extremity Fractures and Unsolved Problems in Guidelines: A Review of Recent Literature. Orthop Surg 2022; 14:1558-1568. [PMID: 35633091 PMCID: PMC9363729 DOI: 10.1111/os.13306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 02/21/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022] Open
Abstract
Deep venous thrombosis (DVT) has been characterized by a disorder of venous return caused by abnormal blood clotting in deep veins. It often occurs in the lower limbs and is a common complication in orthopaedics. Therefore, relevant professional organizations domestic and overseas had formulated and constantly updated relevant guidelines to prevent the occurrence of DVT. According to the management strategy of the guidelines, the incidence of DVT can be significantly reduced. However, due to the variety of fractures types, the guidelines cannot expound precautions and characteristics of DVT for all fracture types at present, and there are other related unresolved problems. For example, there is still a lack of consistent optimal strategies for the management of DVT following isolated lower extremity fractures with a higher incidence. The best anticoagulant strategies for patients with upper limb fractures, pediatric fractures, and those combined with other injuries are rarely described in orthopaedic guidelines, but such fractures are common in clinical orthopaedics. The long‐term complications after DVT, such as post‐thrombotic syndrome, are not well‐understood. In the absence of clear guidance, orthopaedic surgeons often resort to empiric anticoagulation or conservative treatment, so the prevention effects of DVT are inconsistent. The purpose of this review is to summarize the characteristics of DVT events after isolated lower extremity fractures and to discuss the unsolved issues in the guidelines by reviewing the previous literature and tracing the history of DVT discovery, to provide more scientific and comprehensive recommendations for the prediction and prevention of DVT.
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Affiliation(s)
- Wei-Guang Zhao
- Department of Orthopedic Surgery, Handan Central Hospital, HanDan, China
| | - Wei-Li Zhang
- Department of Orthopedic Surgery, Handan Central Hospital, HanDan, China
| | - Ying-Ze Zhang
- Department of Trauma Emergency Center, The Third Hospital of Hebei Medical University, Orthopaedics Research Institution of Hebei Province, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China.,Chinese Academy of Engineering, Beijing, China
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