Risk Factors for Infection and Revision Surgery following Patellar Tendon and Quadriceps Tendon Repairs: An Analysis of 3,442 Patients

2021 ◽  
Author(s):  
Daniel C. Lewis ◽  
Alyssa D. Athoff ◽  
Pramod Kamalapathy ◽  
Seth R. Yarboro ◽  
Mark D. Miller ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Risk Factor ◽  
Patellar Tendon ◽  
Tendon Repair ◽  
Significant Risk ◽  
Multivariate Logistic Regression Analysis ◽  
Quadriceps Tendon ◽  
Extensor Mechanism ◽  
Preoperative Risk Factors

AbstractDisruption of the extensor mechanism is debilitating with surgical repair being the accepted treatment. The incidence of infection and reoperation after extensor mechanism repair are not well reported in the literature. Thus, the objective of the current study was to (1) determine the incidence of surgical site infection and reoperation within 1 year of primary extensor mechanism repair and (2) identify independent risk factors for infection and reoperation following patellar and quadriceps tendon repair. A retrospective review of the 100% Medicare Standard Analytic files from 2005 to 2014 was performed to identify patients undergoing isolated patellar tendon repair and quadriceps tendon repair. Diagnosis of infection within 1 year of operative intervention and revision repair were assessed. Extensor mechanism injuries in the setting of total knee arthroplasty and polytrauma were excluded. Multivariate logistic regression analysis was performed to evaluate risk factors for postoperative infection and reoperation within 1 year. Infection occurred in 6.3% of patients undergoing patellar tendon repair and 2.6% of patients undergoing quadriceps tendon repair. Diabetes mellitus (odds ratio [OR] = 1.89, p = 0.005) was found to be an independent risk factor for infection following patellar tendon repair. Reoperation within 1 year occurred in 1.3 and 3.9% following patellar tendon and quadriceps tendon repair, respectively. Age less than 65 years (OR = 2.77, p = 0.024) and obesity (OR = 3.66, p = 0.046) were significant risk factors for reoperation after patellar tendon repair. Hypertension (OR = 2.13, p = 0.034), hypothyroidism (OR = 2.01, p = 0.010), and depression (OR = 2.41, p = 0.005) were significant risk factors for reoperation after quadriceps tendon repair. Diabetes mellitus was identified as a risk factor for infection after patellar tendon repair. Age less than 65 years, peripheral vascular disease, and congestive heart failure were risk factors for infection after quadriceps tendon repair. The current findings can be utilized to counsel patients regarding preoperative risk factors for postoperative complications prior to surgical intervention for extensor mechanism injuries.

Extensor Mechanism Ruptures and Reruptures: Perioperative Opioid Management

2020 ◽  
Author(s):  
Lafi S. Khalil ◽  
Toufic R. Jildeh ◽  
Najib Ussef ◽  
Tahsin Rahman ◽  
Erika Carter ◽  
...  
Keyword(s):  
Patellar Tendon ◽  
Significant Risk ◽  
Quadriceps Tendon ◽  
Significant Risk Factor ◽  
Extensor Mechanism ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Opioid Medications ◽  
Clinical Records ◽  
Opioid Users

AbstractThe purpose of this study was to determine (1) the correlation between preoperative and postoperative opioid use and (2) risk factors associated with rerupture in patients undergoing open extensor mechanism repair. A retrospective review of patients who underwent operative repair of quadriceps or patellar tendon rupture was performed. Patients were classified as opioid nonusers if they had not received any opioid medications in the 3 months before surgery, or as acute users or chronic users if they received at least one opioid prescription within 1 month or 3 months preceding surgery. Clinical records were reviewed for postoperative opioid use within a year after surgery as well as rerupture rates. A total of 144 quadriceps tendon and 15 patellar tendon repairs were performed at a mean age of 56.8 ± 15.1 years and body mass index of 33.2 ± 7.1. The overall rerupture rate was 6%. Diabetes was a significant risk factor for rerupture (56 vs. 19%, p = 0.023). Chronic preoperative opioid users were more likely to continue to use opioids beyond 1 month postoperatively (p < 0.001) as compared with acute or nonopioid users. Chronic preoperative opioid users (relative risk [RR]: 3.53, 95% confidence interval [CI]: 2.11–5.90) and patients with longer anesthesia time (RR: 1.39, 95% CI: 1.00–1.93) required more monthly opioid refills, whereas tourniquet use required fewer opioid refills each month (RR: 0.57, 95% CI: 0.37–0.88). Compared with patients without a rerupture, each additional prescription refill after the initial repair in the rerupture group was associated with a 22% higher risk of tendon rerupture (RR: 1.22, 95% CI: 1.07–1.39). The chronicity of preoperative opioid intake was found to have a significant effect on postoperative opioid use. This study suggests that there is a higher prevalence of rerupture in patients with prolonged opioid use postoperatively and among diabetics.

Feline diabetes mellitus in the UK: The prevalence within an insured cat population and a questionnaire-based putative risk factor analysis

2007 ◽  
Vol 9 (4) ◽  
pp. 289-299 ◽  
Author(s):  
Theresa M McCann ◽  
Kerry E Simpson ◽  
Darren J Shaw ◽  
Jennifer A Butt ◽  
Danielle A. Gunn-Moore
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Factor Analysis ◽  
Risk Factor ◽  
Classification Tree ◽  
Significant Risk ◽  
Corticosteroid Treatment ◽  
Risk Factor Analysis ◽  
Increased Risk ◽  
The Uk

Prevalence and risk factors for the development of diabetes mellitus (DM) in cats in the United Kingdom have not previously been reported. The prevalence of DM was evaluated in a large insured population and was found to be 1 in 230 cats. In this insured cat population Burmese cats were 3.7 times more likely to develop DM than non-pedigree cats. A convenience-sampling questionnaire-based study was used in order to identify putative risk factors for the development of DM. The univariate risk factor analysis identified being male, neutered, inactive, weighing ≥5 kg and having a history of corticosteroid treatment as significant risk factors for the development of DM in these cats. In addition, male cats treated with megestrol acetate had a significantly increased risk of developing DM compared to females. In contrast, there was no difference in DM occurrence between male and female Burmese cats. A multivariate classification tree-based model on the questionnaire data looking for interactions between risk factors, identified gender as the most important overall risk factor for the development of DM with low physical activity being the next most important risk factor for female cats and breed the next most important for male cats.

scholarly journals Incidence and Risk Factors of Contrast Induced Nephropathy in Patients Following Coronary Angiography

2018 ◽  
Vol 15 (1) ◽  
pp. 20-25
Author(s):  
Mohammed Rashed Anwar ◽  
Abu Noim Md Abdul Hai ◽  
Dilip Kumar Debnath ◽  
Md Anwarul Hoque Faraji ◽  
KAM Mahbub Hasan
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Regression Analysis ◽  
Risk Factor ◽  
Coronary Angiography ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Estimated Gfr ◽  
Contrast Induced Nephropathy ◽  
Contrast Volume

Background: Contrast induced nephropathy (CIN) is a common complication after administration of contrast medium. As the third leading cause of hospital acquired acute kidney injury, CIN occurs in half of the patients undergoing coronary angiography (CAG).Objective: The purpose of the present study was to see the frequency of contrast induced nephropathy in patients after coronary angiography and its risk factors.Methodology: This comparative cross sectional study was performed at National Institute of Kidney Diseases and Urology, Dhaka and Department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July, 2016 to December 2016 for a period of six (06) months. All patients 18 years and above who underwent coronary angiography with or without percutaneuous Transluminal coronary angioplasty with normal or impaired renal function, with or without Diabetes Mellitus or hypertension were included in the study. The patients were divided into two groups named as group A who did not develop CIN and group B developed CIN. Pre- and Post procedure serum creatinine was estimated at 48 hours after coronary angiogram. Independent characteristics associated with CIN were identified.Results: A total number of 250 patients were recruited for this study. Older age ≥70 years, diabetes mellitus were significant risk factor for CIN whereas hypertension was not statistically significant. Logistic regression analysis of risk factors were identified 05 (five) risk factors in this study which were baseline estimated GFR <60mi/min/1.73m2 BSA, diabetes mellitus, contrast volume >100ml, PTCA and LVEF < 40%). Effect of drugs used in the development of CIN by logistic regression analysis. None of the drugs showed significant relationship on development of CIN.Conclusion: Older age, baseline estimated GFR <60mi/min/1.73m2 BSA, diabetes mellitus, contrast volume >100ml, PTCA and LVEF < 40%) were significant risk factor to developed CIN. Journal of Science Foundation 2017;15(1):20-25

Risk Factors for Postoperative Intra-Abdominal Abscess after Laparoscopic Appendectomy: Analysis for Consecutive 1,817 Experiences

2015 ◽  
Vol 32 (5) ◽  
pp. 375-381 ◽  
Author(s):  
Jinbeom Cho ◽  
Ilyoung Park ◽  
Dosang Lee ◽  
Kiyoung Sung ◽  
Jongmin Baek ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Risk Factor ◽  
Laparoscopic Appendectomy ◽  
Significant Risk ◽  
Perforated Appendicitis ◽  
Abdominal Abscess ◽  
Peritoneal Drainage

Background: Possible risk factors for postoperative intra-abdominal abscess (IAA) formation after laparoscopic appendectomy (LA) remain controversial. A perforated appendicitis, diabetes mellitus, peritoneal irrigation, obesity and age are considered to be possible risk factors for postoperative IAA, but the existing evidence is insufficient. This study aimed to identify the risk factors for IAA formation in patients receiving LA. Methods: Between January 2010 and December 2013, 1,817 patients who underwent 3-port LA were enrolled in this study. Patients were classified into 2 groups according to the development of postoperative IAA, and the differences between the groups were analyzed. Results: The incidence of IAA after LA was 1.5%, and the only identified risk factor for IAA was peritoneal irrigation. On logistic regression analysis of those patients who received peritoneal irrigation, suppurative appendicitis and non-placement of the peritoneal drain were found to be significant risk factors for the development of IAA. Conclusions: Peritoneal irrigation in a case of abdomen contamination was shown to be a risk factor for the development of postoperative IAA after LA. When peritoneal irrigation is performed, surgeons should consider using peritoneal drainage and postoperative antibiotics (including anti-anaerobic antibiotics) to prevent postoperative IAA formation.

Risk factor analysis of surgery-related complications in primary cervical spine surgery for degenerative diseases using a surgeon-maintained database

2021 ◽  
Vol 103-B (1) ◽  
pp. 157-163
Author(s):  
Shota Takenaka ◽  
Masafumi Kashii ◽  
Motoki Iwasaki ◽  
Takahiro Makino ◽  
Yusuke Sakai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cervical Spine ◽  
Spine Surgery ◽  
Neurological Deficit ◽  
Significant Risk ◽  
Multivariate Logistic Regression Analysis ◽  
Dural Tear ◽  
Degenerative Diseases ◽  
Cervical Spine Surgery

Aims This study, using a surgeon-maintained database, aimed to explore the risk factors for surgery-related complications in patients undergoing primary cervical spine surgery for degenerative diseases. Methods We studied 5,015 patients with degenerative cervical diseases who underwent primary cervical spine surgery from 2012 to 2018. We investigated the effects of diseases, surgical procedures, and patient demographics on surgery-related complications. As subcategories, the presence of cervical kyphosis ≥ 10°, the presence of ossification of the posterior longitudinal ligament (OPLL) with a canal-occupying ratio ≥ 50%, and foraminotomy were selected. The surgery-related complications examined were postoperative upper limb palsy (ULP) with a manual muscle test (MMT) grade of 0 to 2 or a reduction of two grade or more in the MMT, neurological deficit except ULP, dural tear, dural leakage, surgical-site infection (SSI), and postoperative haematoma. Multivariate logistic regression analysis was performed. Results The significant risk factors (p < 0.050) for ULP were OPLL (odds ratio (OR) 1.88, 95% confidence interval (CI) 1.29 to 2.75), foraminotomy (OR 5.38, 95% CI 3.28 to 8.82), old age (per ten years, OR 1.18, 95% CI 1.03 to 1.36), anterior spinal fusion (OR 2.85, 95% CI 1.53 to 5.34), and the number of operated levels (OR 1.25, 95% CI 1.11 to 1.40). OPLL was also a risk factor for neurological deficit except ULP (OR 5.84, 95% CI 2.80 to 12.8), dural tear (OR 1.94, 95% CI 1.11 to 3.39), and dural leakage (OR 3.15, 95% CI 1.48 to 6.68). Among OPLL patients, dural tear and dural leakage were frequently observed in those with a canal-occupying ratio ≥ 50%. Cervical rheumatoid arthritis (RA) was a risk factor for SSI (OR 10.1, 95% CI 2.66 to 38.4). Conclusion The high risk of ULP, neurological deficit except ULP, dural tear, and dural leak should be acknowledged by clinicians and OPLL patients, especially in those patients with a canal-occupying ratio ≥ 50%. Foraminotomy and RA were dominant risk factors for ULP and SSI, respectively. An awareness of these risks may help surgeons to avoid surgery-related complications in these conditions. Cite this article: Bone Joint J 2021;103-B(1):157–163.

Renal Failure after Coronary Bypass Surgery and the Associated Risk Factors

2015 ◽  
Vol 18 (1) ◽  
pp. 006
Author(s):  
Hasan Reyhanoglu ◽  
Kaan Ozcan ◽  
Murat Erturk ◽  
Fatih İslamoglu ◽  
İsa Durmaz
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Renal Failure ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Significant Risk ◽  
High Morbidity ◽  
Factors Associated

<strong>Objective:</strong> We aimed to evaluate the risk factors associated with acute renal failure in patients who underwent coronary artery bypass surgery.<br /><strong>Methods:</strong> One hundred and six patients who developed renal failure after coronary artery bypass grafting (CABG) constituted the study group (RF group), while 110 patients who did not develop renal failure served as a control group <br />(C group). In addition, the RF group was divided into two subgroups: patients that were treated with conservative methods without the need for hemodialysis (NH group) and patients that required hemodialysis (HR group). Risk factors associated with renal failure were investigated.<br /><strong>Results:</strong> Among the 106 patients that developed renal failure (RF), 80 patients were treated with conservative methods without any need for hemodialysis (NH group); while <br />26 patients required hemodialysis in the postoperative period (HR group). The multivariate analysis showed that diabetes mellitus and the postoperative use of positive inotropes and adrenaline were significant risk factors associated with development of renal failure. In addition, carotid stenosis and postoperative use of adrenaline were found to be significant risk factors associated with hemodialysis-dependent renal failure (P &lt; .05). The mortality in the RF group was determined as 13.2%, while the mortality rate in patients who did not require hemodialysis and those who required hemodialysis was 6.2% and 34%, respectively.<br /><strong>Conclusion:</strong> Renal failure requiring hemodialysis after CABG often results in high morbidity and mortality. Factors affecting microcirculation and atherosclerosis, like diabetes mellitus, carotid artery stenosis, and postoperative vasopressor use remain the major risk factors for the development of renal failure.<br /><br />

Knowledge, awareness and perceptions of diabetes mellitus among the Saudi population

2020 ◽  
Vol 9 (6) ◽  
pp. 413-422
Author(s):  
Muhammad H Mujammami ◽  
Abdulaziz A Alodhayani ◽  
Mohammad Ibrahim AlJabri ◽  
Ahmad Alhumaidi Alanazi ◽  
Sultan Sayyaf Alanazi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Social Media ◽  
Risk Factor ◽  
Healthcare Workers ◽  
Health Workers ◽  
Saudi Population ◽  
Limited Data ◽  
High Prevalence ◽  
Associated Risk Factors

Background: High prevalence of undiagnosed cases of diabetes mellitus (DM) has increased over the last two decades, most patients with DM only become aware of their condition once they develop a complication. Limited data are available regarding the knowledge and awareness about DM and the associated risk factors, complications and management in Saudi society. Aim: This study aimed to assess knowledge of DM in general Saudi society and among Saudi healthcare workers. Results: Only 37.3% of the participants were aware of the current DM prevalence. Obesity was the most frequently identified risk factor for DM. Most comparisons indicated better awareness among health workers. Conclusion: A significant lack of knowledge about DM in Saudi society was identified. Social media and educational curriculum can improve knowledge and awareness of DM.

Prevalence and prognostic impact of left ventricular systolic dysfunction after acute myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T.J Jernberg ◽  
E.O Omerovic ◽  
E.H Hamilton ◽  
K.L Lindmark ◽  
L.D Desta ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Risk Factor ◽  
Reperfusion Therapy ◽  
Left Ventricular ◽  
Funding Source ◽  
Additional Risk Factor ◽  
Additional Risk

Abstract Background Left ventricular dysfunction after an acute myocardial infarction (MI) is associated with poor outcome. The PARADISE-MI trial is examining whether an angiotensin receptor-neprilysin inhibitor reduces the risk of cardiovascular death or worsening heart failure (HF) in this population. The aim of this study was to examine the prevalence and prognosis of different subsets of post-MI patients in a real-world setting. Additionally, the prognostic importance of some common risk factors used as risk enrichment criteria in the PARADISE-MI trial were specifically examined. Methods In a nationwide myocardial infarction registry (SWEDEHEART), including 87 177 patients with type 1 MI between 2011–2018, 3 subsets of patients were identified in the overall MI cohort (where patients with previous HF were excluded); population 1 (n=27 568 (32%)) with signs of acute HF or an ejection fraction (EF) &lt;50%, population 2 (n=13 038 (15%)) with signs of acute HF or an EF &lt;40%, and population 3 (PARADISE-MI like) (n=11 175 (13%)) with signs of acute HF or an EF &lt;40% and at least one risk factor (Age ≥70, eGFR &lt;60, diabetes mellitus, prior MI, atrial fibrillation, EF &lt;30%, Killip III-IV and STEMI without reperfusion therapy). Results When all MIs, population 1 (HF or EF &lt;50%), 2 (HF or EF &lt;40%) and 3 (HF or EF &lt;40% + additional risk factor (PARADISE-MI like)) were compared, the median (IQR) age increased from 70 (61–79) to 77 (70–84). Also, the proportion of diabetes (22% to 33%), STEMI (38% to 50%), atrial fibrillation (10% to 24%) and Killip-class &gt;2 (1% to 7%) increased. After 3 years of follow-up, the cumulative probability of death or readmission because of heart failure in the overall MI population and in population 1 to 3 was 17.4%, 26.9%, 37.6% and 41.8%, respectively. In population 2, all risk factors were independently associated with death or readmission because of HF (Age ≥70 (HR (95% CI): 1.80 (1.66–1.95)), eGFR &lt;60 (1.62 (1.52–1.74)), diabetes mellitus (1.35 (1.26–1.44)), prior MI (1.16 (1.07–1.25)), atrial fibrillation (1.35 (1.26–1.45)), EF &lt;30% (1.69 (1.58–1.81)), Killip III-IV (1.34 (1.19–1.51)) and STEMI without reperfusion therapy (1.34 (1.21–1.48))) in a multivariable Cox regression analysis. The risk increased with increasing number of risk factors (Figure 1). Conclusion Depending on definition, post MI HF is present in 13–32% of all MI patients and is associated with a high risk of subsequent death or readmission because of HF. The risk increases significantly with every additional risk factor. There is a need to optimize management and improve outcomes for this high risk population. Figure 1 Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Novartis

Comorbidity and severity-of-illness risk adjustment for hospital-onset Clostridioides difficile infection using data from the electronic medical record

2020 ◽  
pp. 1-7
Author(s):  
Stephanie M. Cabral ◽  
Katherine E. Goodman ◽  
Natalia Blanco ◽  
Surbhi Leekha ◽  
Larry S. Magder ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Risk Adjustment ◽  
Community Hospital ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Bivariate Analysis ◽  
Patient Admissions ◽  
Clostridioides Difficile ◽  
Risk Adjustment Model

Abstract Objective: To determine whether electronically available comorbidities and laboratory values on admission are risk factors for hospital-onset Clostridioides difficile infection (HO-CDI) across multiple institutions and whether they could be used to improve risk adjustment. Patients: All patients at least 18 years of age admitted to 3 hospitals in Maryland between January 1, 2016, and January 1, 2018. Methods: Comorbid conditions were assigned using the Elixhauser comorbidity index. Multivariable log-binomial regression was conducted for each hospital using significant covariates (P < .10) in a bivariate analysis. Standardized infection ratios (SIRs) were computed using current Centers for Disease Control and Prevention (CDC) risk adjustment methodology and with the addition of Elixhauser score and individual comorbidities. Results: At hospital 1, 314 of 48,057 patient admissions (0.65%) had a HO-CDI; 41 of 8,791 patient admissions (0.47%) at community hospital 2 had a HO-CDI; and 75 of 29,211 patient admissions (0.26%) at community hospital 3 had a HO-CDI. In multivariable regression, Elixhauser score was a significant risk factor for HO-CDI at all hospitals when controlling for age, antibiotic use, and antacid use. Abnormal leukocyte level at hospital admission was a significant risk factor at hospital 1 and hospital 2. When Elixhauser score was included in the risk adjustment model, it was statistically significant (P < .01). Compared with the current CDC SIR methodology, the SIR of hospital 1 decreased by 2%, whereas the SIRs of hospitals 2 and 3 increased by 2% and 6%, respectively, but the rankings did not change. Conclusions: Electronically available patient comorbidities are important risk factors for HO-CDI and may improve risk-adjustment methodology.

Risk Factors for Aortic Valve Calcification in Patients on Regular Hemodialysis

2009 ◽  
Vol 32 (3) ◽  
pp. 173-179 ◽  
Author(s):  
Dejan Petrović ◽  
Radmila Obrenović ◽  
Biljana Stojimirović
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Risk Factor ◽  
Aortic Valve ◽  
Independent Risk Factor ◽  
Multivariate Logistic Regression Analysis ◽  
Multivariate Logistic Regression ◽  
Aortic Valve Calcification ◽  
Valve Calcification ◽  
Regular Hemodialysis

Introduction Aortic valve calcification (AVC) accelerates development of aortic valve stenosis and cardiovascular complications. Hyperphosphatemia is one of the key risk factors for aortic valve calcification. Aim The aim of this study was to evaluate the prevalence of AVC in patients on regular hemodialysis and to assess the impact of different factors on its appearance. Method: The study investigated a total of 115 patients treated in the Hemodialysis Department of the Urology and Nephrology Clinic at the Kragujevac Clinical Center in Serbia. The variables investigated were: serum albumin, C-reactive protein (CRP), homocysteine, total cholesterol, LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), triglycerides (TG), Apolipoprotein A-I (Apo A-I), Apolipoprotein B (Apo B) and lipoprotein (a), calcium, phosphate and parathormone, and calcium-phosphorus product (Ca × P). Patients were evaluated by echocardiography for AVC. Statistical analysis included univariate and multivariate logistic regression analysis. Results Univariate regression analysis showed that serum phosphate levels and Ca × P are the most important risk factors for AVC (p<0.001). Multivariate logistic regression analysis revealed that hyperphosphatemia is an independent risk factor for AVC (p<0.001). Conclusion Hyperphosphatemia is an independent risk factor for aortic valve calcification.

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