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Okpara S, Lee T, Pathare N, Ghali A, Momtaz D, Ihekweazu U. Cardiovascular Disease in Total Knee Arthroplasty: An Analysis of Hospital Outcomes, Complications, and Mortality. Clin Orthop Surg 2024; 16:265-274. [PMID: 38562631 PMCID: PMC10973625 DOI: 10.4055/cios23224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/16/2023] [Accepted: 09/16/2023] [Indexed: 04/04/2024] Open
Abstract
Background Cardiovascular comorbidities have been identified as a significant risk factor for adverse outcomes following surgery. The purpose of this study was to investigate its prevalence and impact on postoperative outcomes, hospital metrics, and mortality in patients undergoing total knee arthroplasty (TKA). Our hypothesis was that patients with cardiovascular comorbidities would have worse outcomes, greater postoperative complication rates, and increased mortality compared to patients without cardiovascular disease. Methods In this retrospective study, data from the National Inpatient Sample database from 2011 to 2020 were queried for patients who underwent TKA with preexisting cardiac comorbidities, including congestive heart failure (CHF), coronary artery disease (CAD), valvular dysfunction, and arrhythmia. Multivariate logistic regression analyses compared hospital metrics (length of stay, costs, and adverse discharge disposition), postoperative complications, and mortality rates while adjusting for demographic and clinical variables. All statistical analyses were performed using R studio 4.2.2 and Stata MP 17 and 18 with Python package. Results A total of 385,585 patients were identified. Those with preexisting CHF, CAD, valvular dysfunction, or arrhythmias were found to be older and at higher risk of adverse outcomes, including prolonged length of stay, increased hospital charges, and increased mortality (p < 0.001). Additionally, all preexisting cardiac diagnoses led to an increased risk of postoperative myocardial infarction, acute kidney injury (AKI), and need for transfusion (p < 0.001). The presence of valvular dysfunction, arrhythmia, or CHF was associated with an increased risk of thromboembolic events (p < 0.001). The presence of CAD and valvular dysfunction was associated with an increased risk of urologic infection (p < 0.001). Conclusions This study demonstrated that CHF, CAD, valvular dysfunction, and arrhythmia are prevalent among TKA patients and associated with worse hospital metrics, higher risk of perioperative complications, and increased mortality. As our use of TKA rises, a lower threshold for preoperative cardiology referral in older individuals and early preoperative counseling/intervention in those with known cardiac disease may be necessary to reduce adverse outcomes.
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Affiliation(s)
- Shawn Okpara
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Tiffany Lee
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Nihar Pathare
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Abdullah Ghali
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - David Momtaz
- Department of Orthopedics, UT Health Science Center at San Antonio, San Antonio, TX, USA
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Momtaz D, Okpara S, Martinez A, Cushing T, Ghali A, Gonuguntla R, Kotzur T, Duruewuru A, Harris M, Seifi A, Harrington M. A modified frailty index predicts complication, readmission, and 30-day mortality following the revision total hip arthroplasty. Arthroplasty 2024; 6:7. [PMID: 38310263 PMCID: PMC10838456 DOI: 10.1186/s42836-024-00232-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/02/2024] [Indexed: 02/05/2024] Open
Abstract
INTRODUCTION This study aimed to develop a modified frailty index (MFI) to predict the risks of revision total hip arthroplasty (THA). METHODS Data from the American College of Surgeons - National Surgical Quality Improvement Program were analyzed for patients who underwent revision THA from 2015 to 2020. An MFI was composed of the risk factors, including severe obesity (body mass index > 35), osteoporosis, non-independent function status prior to surgery, congestive heart failure within 30 days of surgery, hypoalbuminemia (serum albumin < 3.5), hypertension requiring medication, type 1 or type 2 diabetes, and a history of chronic obstructive pulmonary disease or pneumonia. The patients were assigned based on the MFI scores (MFI0, no risk factor; MFI1, 1-2 risk factors; MFI2, 3-4 risk factors; and MFI3, 5+ risk factors). Confidence intervals were set at 95% with a P value less than or equal to 0.05 considered statistically significant. RESULTS A total of 17,868 patients (45% male, 55% female) were included and had an average age of 68.5 ± 11.5 years. Odds of any complication, when compared to MFI0, were 1.4 (95% CI [1.3, 1.6]) times greater for MFI1, 3.2 (95% CI [2.8, 3.6]) times greater for MFI2, and 10.8 (95% CI [5.8, 20.0]) times greater for MFI3 (P < 0.001). Odds of readmission, when compared to MFI0, were 1.4 (95% CI [1.3, 1.7]) times greater for MFI1, 2.5 (95% CI [2.1, 3.0]) times greater for MFI2, and 4.1 (95% CI [2.2, 7.8]) times greater for MFI3 (P < 0.001). CONCLUSION Increasing MFI scores correlate with increased odds of complication and readmission in patients who have undergone revision THA. This MFI may be used to predict the risks after revision THA.
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Affiliation(s)
- David Momtaz
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Shawn Okpara
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Armando Martinez
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Tucker Cushing
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Abdullah Ghali
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA.
| | - Rishi Gonuguntla
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Travis Kotzur
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Anthony Duruewuru
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Madison Harris
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Ali Seifi
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Melvyn Harrington
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
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Uche NJ, Uche EO, Eze BI, Amuta DS, Guga DA, Okpara S. Neurophthalmic manifestations of giant sellar tumors in adults: Relationship between endocrine status and visual acuity profile pre and postsurgical treatment: A prospective cohort study. Niger J Clin Pract 2020; 23:1500-1506. [PMID: 33221772 DOI: 10.4103/njcp.njcp_340_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective To evaluate the relationship between visual acuity (VA) and endocrine status among patients with giant sellar tumors pre and postsurgical treatment. Methods A 7-year single institution prospective cohort study of patients with giant sellar tumors treated by pterional transylvian microsurgical resection. Patients were evaluated and followed-up by a collaborative team of ophthalmologists and neurosurgeons. Results Sellar tumors represent 25% of our brain tumors cases (n = 257). Giant sellar tumors were 61 (23.7%) cases. Pituitary adenomas occurred in 40 patients and in 24 of these, the tumor was a functional adenoma. The age range was 16 to 75 years with a mean of 43.7 ± 3.3 years. Visual impairment (n = 60), headache (n = 55), and endocrinopathy (24) were among the common manifestations. VA and visual field defects were experienced by 59 and 39 patients, respectively. For both eyes, endocrine active tumors presented with poorer preoperative VA profile using mean logMAR VA [(χ2 = 10.3, P = 0.002 OD) and (χ2 = 8.9, P = 0.003 OS)]. Postoperatively, the mean logMAR VA profiles of endocrine active tumors showed a significantly better response when compared to endocrine inactive tumors in both eyes [(χ2 = 5.53, P = 0.029 OD) and (χ2 = 6.77, P = 0.037 OS)]. Conclusion Visual acuity defects are almost invariable in patients with giant sellar tumor and may be associated with an endocrine profile. Surgical resection with normalization of hormone status is rewarded with VA improvement.
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Affiliation(s)
- N J Uche
- Department of Ophthalmology, College of Medicine, University of Nigeria, Ituku/Ozalla Campus, Enugu, Nigeria
| | - E O Uche
- Department of Surgery; Department of Surgery, University of Nigeria Teaching Hospital Ituku/Ozalla Campus, Enugu, Nigeria
| | - B I Eze
- Department of Surgery, University of Nigeria Teaching Hospital Ituku/Ozalla Campus, Enugu, Nigeria
| | - D S Amuta
- Department of Surgery, University of Nigeria Teaching Hospital Ituku/Ozalla Campus, Enugu, Nigeria
| | - D A Guga
- Department of Surgery, University of Nigeria Teaching Hospital Ituku/Ozalla Campus, Enugu, Nigeria
| | - S Okpara
- Department of Surgery, University of Nigeria Teaching Hospital Ituku/Ozalla Campus, Enugu, Nigeria
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Okpara S, Nakonezny P, Wells J. Do psychological factors or radiographic severity play a role in the age of onset in symptomatic developmental dysplasia of hip and femoroacetabular impingement syndrome? BMC Musculoskelet Disord 2019; 20:412. [PMID: 31488106 PMCID: PMC6728945 DOI: 10.1186/s12891-019-2784-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/27/2019] [Indexed: 12/17/2022] Open
Abstract
Background Age of onset in symptomatic developmental dysplasia of the hip (DDH) and femoroacetabular impingement syndrome (FAIS) varies. The purpose of this study was to investigate whether psychological factors, radiographic, and clinical variables were related to age of onset of hip pain in DDH and FAIS. Methods We collected demographic, clinical, and radiographic data on 56 DDH and 84 FAIS patients. Each was diagnosed based on radiographic findings and clinical history. Age of onset was operationalized by subtracting patient reported duration of symptoms from patient age at presentation. Pain catastrophizing (PCS) and depression were assessed with the pain catastrophizing scale and hospital anxiety and depression scale (HADS), respectively. Multiple linear regression modeling, with Lasso variable selection, was implemented. Results Pain catastrophizing, anxiety, and depression were not significantly related to age of DDH onset (p-values > 0.27) or age of FAIS onset (p-values > 0.29). LASSO-penalized linear regression revealed alpha Dunn angle, Tonnis grade, prior hip surgery, WOMAC pain score, and iHOT total score were associated with age of onset in FAIS (Adjusted R2 = 0.3099). Lateral center edge angle (LCEA), alpha frog angle, Tonnis grade, SF12 physical functioning, and body mass index (BMI) were associated with age of DDH onset (Adjusted R2 = 0.3578). Conclusions Psychological factors, as measured by PCS and HADS, were not associated with age of onset in DDH or FAIS. Functional impairment as measured by WOMAC pain and impaired active lifestyle as measured by iHOT were found to affect age of FAIS onset. For DDH, impaired physical functioning and increasing BMI were found to be associated with age of onset. Severity of the disease, as measured radiographically by LCEA and alpha Dunn angle, was also found to be associated with earlier age of onset in DDH and FAIS, respectively. A patient’s radiographic severity may have more of a relationship to the onset of pain than physiologic factors.
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Affiliation(s)
- Shawn Okpara
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Rd 1st floor, Dallas, TX, 75390, USA
| | - Paul Nakonezny
- Department of Population and Data Sciences, Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas, USA
| | - Joel Wells
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Rd 1st floor, Dallas, TX, 75390, USA.
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Wimberly J, Okpara S, Zimmern P. MP40-20 DO SURGEONS WISH TO KNOW ABOUT THEIR LONG-TERM COMPLICATIONS? J Urol 2017. [DOI: 10.1016/j.juro.2017.02.1267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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