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Girdler SJ, Maza N, Lieber AM, Vervaecke A, Kodali H, Zubizarreta N, Poeran J, Cagle PJ, Galatz LM. Impact of Surgeon Case Volume on Outcomes After Reverse Total Shoulder Arthroplasty. J Am Acad Orthop Surg 2023; 31:1228-1235. [PMID: 37831947 DOI: 10.5435/jaaos-d-23-00181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/01/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION Despite a rapid increase in utilization of reverse total shoulder arthroplasty (rTSA), volume-outcome studies focusing on surgeon volume are lacking. Surgeon-specific volume-outcome studies may inform policymakers and provide insight into learning curves and measures of efficiency with greater case volume. METHODS This retrospective cohort study with longitudinal data included all rTSA cases as recorded in the Centers for Medicare & Medicaid Services Limited Data Set (2016 to 2018). The main effect was surgeon volume; this was categorized using two measures of surgeon volume: (1) rTSA case volume and (2) rTSA + TSA case volume. Volume cutoff values were calculated by applying a stratum-specific likelihood ratio analysis. RESULTS Among 90,318 rTSA cases performed by 7,097 surgeons, we found a mean annual rTSA surgeon volume of 6 ± 10 and a mean rTSA + TSA volume of 9 ± 14. Regression models using surgeon-specific rTSA volume revealed that surgery from low (<29 cases) compared with medium (29 to 96 cases) rTSA-volume surgeons was associated with a significantly higher 90-day all-cause readmission (odds ratio [OR], 1.17; confidence interval [CI], 1.10 to 1.25; P < 0.0001), higher 90-day readmission rates because of an infection (OR, 1.46; CI, 1.16 to 1.83; P = 0.0013) or dislocation (OR, 1.43; CI, 1.19 to 1.72; P = 0.0001), increased 90-day postoperative cost (+11.3% CI, 4.2% to 19.0%; P = 0.0016), and a higher transfusion rate (OR, 2.06; CI, 1.70 to 2.50; P < 0.0001). Similar patterns existed when using categorizations based on rTSA + TSA case volume. CONCLUSION Surgeon-specific volume-outcome relationships exist in this rTSA cohort, and we were able to identify thresholds that may identify low and medium/high volume surgeons. Observed volume-outcome relationships were independent of the definition of surgeon volume applied: either by focusing on the number of rTSAs performed per surgeon or anatomic TSAs performed. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Steven J Girdler
- From the Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY
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Samuel AM, Morse K, Lovecchio F, Maza N, Vaishnav AS, Katsuura Y, Iyer S, McAnany SJ, Albert TJ, Gang CH, Qureshi SA. Early Failures After Lumbar Discectomy Surgery: An Analysis of 62 690 Patients. Global Spine J 2021; 11:1025-1031. [PMID: 32677471 PMCID: PMC8351058 DOI: 10.1177/2192568220935404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To determine the rate of early failures (readmission or reoperation for new or recurrent pain/neurological symptoms) within 30 days after lumbar discectomy and identify associated risk factors. METHODS A retrospective cohort study was conducted of patients undergoing lumbar discectomy in the National Surgical Quality Improvement Program database between 2013 and 2017. Rates of readmission for new or recurrent symptoms or reoperation for revision discectomy or fusion within 30 days postoperatively were measured and correlated with risk factors. RESULTS In total 62 690 patients were identified; overall rate of readmission within 30 days was 3.3%, including 1.2% for pain or neurological symptoms. Populations at increased risk of readmission were those with 3 or more levels of treatment (2.0%, odds ratio [OR] 2.8%, P < .01), age >70 years (1.8%, OR 1.6, P < .01), class 3 obesity (1.5%, OR 1.4, P = .04), and female gender (1.4%, OR 1.2, P = .02). The overall rate of reoperation within 30 days was 2.2%, including 1.2% for revision decompression or lumbar fusion surgery. Populations at increased risk of reoperation were revision discectomies (1.4%, OR 1.7, P < .01) and females (1.1%, OR 1.4, P < 0.01). Extraforaminal discectomies were associated with lower rates of readmission (0.7%, OR 0.6, P = 0.02) and reoperation (0.4%, OR 0.4, P = .01). CONCLUSIONS Early failures after lumbar discectomy surgery are rare. However, certain subpopulations are associated with increased rates of early failure: obesity, multilevel surgery, females, and revision discectomies.
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Affiliation(s)
| | - Kyle Morse
- Hospital for Special Surgery, New York, NY, USA
| | | | - Noor Maza
- Ichan School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Yoshihiro Katsuura
- Hospital for Special Surgery, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA
| | - Sravisht Iyer
- Hospital for Special Surgery, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA
| | - Steven J. McAnany
- Hospital for Special Surgery, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA
| | - Todd J. Albert
- Hospital for Special Surgery, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA
| | | | - Sheeraz A. Qureshi
- Hospital for Special Surgery, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA,Sheeraz A. Qureshi, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA.
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Romero JM, Liberato ACP, Montes D, Barnaure I, Xu J, Maza N, Gonzalez RG. Accuracy of MRI T2*-weighted sequences (GRE-EPI) compared to CTA for detection of anterior circulation large vessel thrombus. Emerg Radiol 2020; 27:269-275. [DOI: 10.1007/s10140-020-01754-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/09/2020] [Indexed: 01/02/2023]
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Hadi M, Maxwell AW, Hirsch JA, Gonzalez RG, Maza N, Romero JM. Clinico-radiologic factors in paraclinoid aneurysms associated with aneurysm rupture: A CTA study. Clin Imaging 2019; 53:225-229. [DOI: 10.1016/j.clinimag.2018.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/03/2018] [Accepted: 10/17/2018] [Indexed: 11/24/2022]
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Rueckl K, Boettner F, Maza N, Runer A, Bechler U, Sculco P. The posterior-anterior flexed view is better than the anterior-posterior view for assessing osteoarthritis of the knee. Skeletal Radiol 2018; 47:511-517. [PMID: 29159676 DOI: 10.1007/s00256-017-2815-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/27/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study is to determine whether the posterior-anterior (PA)-flexed view improves the radiographic assessment of patients with knee pain compared with the standard standing anterior-posterior radiograph. MATERIALS AND METHODS Three hundred and sixty-five patients with knee pain underwent anterior-posterior (AP), PA flexed, lateral, and Merchant radiographs of the knee. Knees were grouped as mild (Kellgren and Lawrence [K-L] 1-2) or severe (K-L 3-4) osteoarthritis (OA) and either varus (medial compartment), valgus (lateral compartment), or patellofemoral OA. RESULTS In knees with mild valgus OA on AP view (K-L 1-2), the PA flexed view was more sensitive than the AP view. The measured lateral minimal joint space width (minJSW) decreased more than 2 mm in 68% of the patients, resulting in an increase in K-L grade (3 or 4). In patients with severe valgus OA and in all patients with varus and patellofemoral OA, there was no difference between AP and PA flexed view with regard to radiographic measurements or KL grade. Based on the Medicare reimbursement rate using the PA flexed view alone instead of both views reduced imaging costs by 47%. CONCLUSION The PA flexed view better classifies the severity of lateral compartment disease in patients with mild valgus OA and provides comparable diagnostic sensitivity for joint space narrowing in varus- and patellofemoral OA. Using the PA flexed view alone was more cost effective than using the combination of AP and PA flexed imaging.
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Affiliation(s)
- Kilian Rueckl
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Friedrich Boettner
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Noor Maza
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.,Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA
| | - Armin Runer
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Ulrich Bechler
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Peter Sculco
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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Chang J, Arani K, Chew S, Frosch MP, Gonzalez RG, Maza N, Romero JM. Susceptibility Etching on MRI in Patients with Microangiopathy. J Neuroimaging 2016; 27:43-49. [PMID: 27539492 DOI: 10.1111/jon.12384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 07/11/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND We detected a novel imaging sign, which consists of a specific imaging pattern of diffuse susceptibility effect, delineating the cortical-subcortical junction on high-resolution susceptibility-weighted images (SWIs). We describe magnetic resonance imaging findings in 10 patients with "susceptibility etching" and possible association with their abnormal coagulation profile. MATERIALS/METHODS A retrospective case series study with a search for cases that demonstrated susceptibility effect at the cortical-subcortical junction on SWI sequences was performed. The patients' respective coagulation profiles including prothrombin time, partial thromboplastin time, fibrinogen, D-dimer values, and platelet counts were reviewed. In addition, clinical history and neurological deficits were recorded. RESULTS We identified 10 patients with the "susceptibility etching" pattern at the cortical-subcortical junction. All patients were acutely ill and had a significantly elevated D-dimer (4,309 mcg/L to >10,000 mcg/L) with variably reduced platelet count. Two patients had reduced fibrinogen and 5 patients had prolonged international normalized ratio. Of the 10 patients, 4 died during hospitalization, within a few days of imaging. Pathology of 1 patient at autopsy demonstrated findings suggestive of a microvascular thrombotic or embolic event without overt parenchymal microhemorrhage. CONCLUSION In this preliminary case series, we describe patients with "susceptibility etching" on SWI who were also found to have profound coagulation impairment. While other comorbities may also contribute to this novel sign, we suggest that a possible etiology may be secondary to microvascular in situ formation of fine thrombi and/or emboli lodged into an area of vascular caliber reduction and maybe related to thrombotic microangiopathy.
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Affiliation(s)
- Jennifer Chang
- Department of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Keerthi Arani
- Department of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Sheena Chew
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Matthew P Frosch
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - R Gilberto Gonzalez
- Department of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Noor Maza
- Department of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Javier M Romero
- Department of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Liberato AP, Shah S, Maza N, Barnaure I, Gonzalez RG, Romero JM. Abstract TP39: High Accuracy of Magnetic Resonance T2*- Weighted Sequences for Detection of Intracranial Arterial Thrombus. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.tp39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Rapid detection and location of vessel occlusion are pivotal in the intra-arterial management of patients with acute stroke in the emergency room. MRI has demonstrated to detect intravascular thrombus but its accuracy compared to CT angiography has not been well established.
Hypothesis:
Our purpose is to determine the accuracy of 1.5 T MRI T2*-weighted (W) sequences compared to immediate CT angiography as the standard reference imaging modality, for detection of intra-arterial thrombus in patients with suspected acute MCA infarction.
Methods:
Consecutive patients with suspected middle cerebral artery (MCA) territory stroke were selected from 2008 to 2009. The inclusion criteria for the study subjects: CTA, T2*W sequences included on MRI protocol and restricted diffusion in MCA territory on DWI within 12 hrs of clinical onset. Two investigators reviewed DWI and T2*W sequences for the presence of infarction and thrombus. Intracranial internal carotid artery (ICA), M1 and M2 segments of the MCA were accessed. Consensus was reached with a third reviewer for data analyses. Accuracy, sensitivity, specificity, positive and negative predictive values (PPV/NPV) were calculated.
Results:
Fifty-one patients were included in the study, of which 40 patients had confirmed arterial thrombus and 11 patients had normal studies on CTA. Of the subjects with arterial occlusion on CTA, the mean time interval from stroke onset to CTA was 4.2 h +/- 2.3 h (range, 0.4-12h). The mean time interval from CTA to MRI was 29.5 min +/- 11.1 min. Twenty-six cases showed M1 thrombus on CTA, of these, 22 cases had corresponding thrombus and 4 cases had no abnormality in T2*W sequences on MRI. Nevertheless, 25 patients demonstrated no M1 thrombus, either on CTA or MRI. After statistical analyses, we observed an accuracy of 92%, sensitivity of 85%, specificity of 100%, PPV 100% and NPV of 86% for M1 occlusion. The Kappa obtained was 0.79.
Conclusion:
In conclusion, T2*W sequences demonstrated overall high accuracy and specificity for detection of arterial thrombus in the M1 segment of the MCA in patients with suspected acute MCA ischemic stroke.
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Affiliation(s)
| | - Santosh Shah
- Div of Neuroradiology, Massachusetts General Hosp, Boston, MA
| | - Noor Maza
- Div of Neuroradiology, Massachusetts General Hosp, Boston, MA
| | | | | | - Javier M Romero
- Div of Neuroradiology, Massachusetts General Hosp, Boston, MA
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