Unplanned Reoperation and Implant Revision After Total Wrist Arthroplasty

Background: Total wrist arthroplasty (TWA) is a treatment option for many debilitating wrist conditions. With recent improvements in implant design, indications for TWA have broadened. However, despite these improvements, there are still complications associated with TWA, such as unplanned reoperation and eventual implant removal. The goal of this study was to identify risk factors for an unplanned reoperation or implant revision after a TWA at 2 academic medical centers between 2002 and 2015. Methods: In this retrospective study, 24 consecutive TWAs were identified using CPT codes. Medical records were manually reviewed to identify demographic, patient- or disease-related, and surgery-related risk factors for reoperation and implant removal after a primary TWA. Results: Forty-six percent of wrists (11 of 24 TWAs performed) had a reoperation after a median of 3.4 years, while 29% (7 of 24) underwent implant revision after a median of 5 years. Two patients had wrist surgery prior to their TWA, both eventually had their implant removed ( P = .08). There were no risk factors associated with reoperation or implant removal. Conclusion: Unplanned reoperation and implant removal after a primary TWA are common. Approximately 1 in 3 wrists are likely to undergo revision surgery. We found no factors associated with reoperation or implant removal; however, prior wrist surgery showed a trend toward risk of implant removal after TWA.

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Organizational Factors Associated with High Performance in Quality and Safety in Academic Medical Centers

Academic Medicine ◽

10.1097/acm.0b013e318159e1ff ◽

2007 ◽

Vol 82 (12) ◽

pp. 1178-1186 ◽

Cited By ~ 94

Author(s):

Mark A. Keroack ◽

Barbara J. Youngberg ◽

Julie L. Cerese ◽

Cathleen Krsek ◽

Leslie W. Prellwitz ◽

...

Keyword(s):

High Performance ◽

Organizational Factors ◽

Academic Medical Centers ◽

Quality And Safety ◽

Factors Associated ◽

Medical Centers ◽

Academic Medical

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244Organizational Factors Associated with Antibacterial Use Among Academic Medical Centers

Open Forum Infectious Diseases ◽

10.1093/ofid/ofu052.110 ◽

2014 ◽

Vol 1 (suppl_1) ◽

pp. S105-S105

Author(s):

Amy Pakyz ◽

Jenna Short ◽

Hui Wang ◽

Sam Hohmann

Keyword(s):

Academic Medical Centers ◽

Factors Associated ◽

Medical Centers ◽

Academic Medical

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1178. Risk factors for death among patients with Candida endocarditis: An observational study in US academic medical centers

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1364 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S614-S614

Author(s):

Jonathan Huggins ◽

Michael Z David ◽

Samuel F Hohmann

Keyword(s):

Risk Factors ◽

Liver Failure ◽

Case Series ◽

Academic Medical Centers ◽

Hospital Death ◽

Hepatitis C Infection ◽

Risk Of Death ◽

Medical Centers ◽

Opiate Abuse ◽

Academic Medical

Abstract Background Candida endocarditis is a rare, sometimes fatal complication candidemia. Our understanding of this condition is limited to findings from case series and small observational studies. Using the Vizient clinical database, a repository for clinical and administrative data from 117 academic medical centers and more than 300 affiliated hospitals, we assembled the largest cohort of Candida endocarditis patients to date, reporting patient characteristics and risk factors for death. Methods Using ICD-10 code B37.6 (Candidal Endocarditis) we identified 703 inpatients at 179 United States hospitals from October 2015 through April 2019. We examined demographic, diagnostic, and procedural data from each patient’s initial encounter. With univariate and multivariate logistic regression analyses we identified predictors of in-hospital mortality. Results Of 703 patients, 402 (57.2%) were male, 421 (59.9%) used tobacco, 213 (30.3%) had documented opiate abuse, 128 (18.2%) had other illicit drug abuse documented, and 190 (27.0%) had documented hepatitis C infection. Among the 703 patients, 114 (16.2%) died during the index encounter. On multivariate analysis, liver failure was the strongest predictor of death (OR 8.4, 95% CI 4.4 – 15.9), and female sex (OR 1.8, 95% CI 1.1 – 2.9), transfer from an outside facility (OR 1.7, 95% CI 1.1 – 2.7), underlying aortic valve pathology (OR 2.8, 95% CI 1.5 – 4.9), hemodialysis (OR 2.0, 95% CI 1.0 – 3.8), cerebrovascular disease (OR 2.2, 95% CI 1.2 – 3.8), neutropenia (OR 2.5, 95% CI 1.3 – 4.7) and alcohol abuse (OR 2.9, 95% CI 1.3 – 6.7) were also associated with higher odds of in-hospital death. In the same analysis, opiate abuse was associated with a lower odds of in-hospital death (OR 0.4, 95% CI 0.2 – 0.8). Table 1. Characteristics of 703 patients with Candida endocarditis Table 2. Factors associated with in-hospital death in multivariate regression analysis Conclusion We found that for patients Candida endocarditis inpatient mortality was 16.2% and liver failure was associated with a high risk of death while opiate abuse was protective. Further investigation is necessary to better understand these associations. Disclosures Michael Z. David, MD PhD, GSK (Consultant)

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