Unanticipated Admission Following Outpatient Ligament Reconstruction and Tendon Interposition: An Analysis of 3966 Cases

Hand ◽  
2020 ◽  
pp. 155894472093920
Author(s):  
Andrew M. Hresko ◽  
Justin E. Kleiner ◽  
Lindsay R. Kosinski ◽  
Avi D. Goodman ◽  
Joseph A. Gil
Keyword(s):  
Ligament Reconstruction ◽  
Statistical Significance ◽  
The United States ◽  
Unplanned Admission ◽  
Improvement Program ◽  
Steroid Use ◽  
White Race ◽  
Multivariable Regression ◽  
Unanticipated Admission ◽  
Tendon Interposition

Background: Hand surgeons in the United States commonly perform ligament reconstruction and tendon interposition (LRTI) to address debilitating thumb carpometacarpal arthritis. The objective of this investigation was to examine the characteristics that place patients at risk for unanticipated inpatient admission after a planned outpatient LRTI. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) datasets from years 2009 to 2016 were used to identify patients with a primary Current Procedural Terminology code for LRTI (25445, 25447). Only outpatient, nonemergent, and elective procedures were considered. Univariable and multivariable regression were used to determine risk factors and postoperative complications associated with increased likelihood of unanticipated admission, defined as length of initial hospital stay greater than 0 days. Statistical significance was set at P < .05. Results: Of 3966 patients who underwent outpatient LRTI, 134 (3.4%) had unplanned admission. On multivariable regression, age ≥ 65 years (odds ratio [OR] = 1.50), white race (OR = 4.44), and chronic steroid use (OR = 2.42) were significant predictors of unplanned admission. History of smoking, obesity, hypertension, diabetes, American Society of Anesthesiologists classification, and anesthesia method were not associated with admission. Patients who had unplanned admission had increased rate of reoperation (2.5% vs 0.3%) compared with nonadmitted patients. There was no difference in rate of postoperative infection, deep vein thrombosis, wound dehiscence, or 30-day mortality. Conclusions: Age ≥ 65 years, chronic steroid use, and white race were significant predictors of unplanned admission following LRTI. Identifying patients with these characteristics will be critical in risk adjusting the anticipated cost of the episode of care in outpatient LRTI.

scholarly journals Application of Geographical Information System Techniques to Determine High Crash-Prone Areas in the Fort Peck Indian Reservation

2020 ◽  
Vol 14 (1) ◽  
pp. 174-185
Author(s):  
Sahima Nazneen ◽  
Mahdi Rezapour ◽  
Khaled Ksaibati
Keyword(s):  
Information System ◽  
High Risk ◽  
Injury Severity ◽  
Statistical Significance ◽  
Temporal Analysis ◽  
The United States ◽  
Geographical Information ◽  
Improvement Program ◽  
Indian Reservation ◽  
Road Segments

Background: Historically, Indian reservations have been struggling with higher crash rates than the rest of the United States. In an effort to improve roadway safety in these areas, different agencies are working to address this disparity. For any safety improvement program, identifying high risk crash locations is the first step to determine contributing factors of crashes and select corresponding countermeasures. Methods: This study proposes an approach to determine crash-prone areas using Geographic Information System (GIS) techniques through creating crash severity maps and Network Kernel Density Estimation (NetKDE). These two maps were assessed to determine the high-risk road segments having a high crash rate, and high injury severity. However, since the statistical significance of the hotspots cannot be evaluated in NetKDE, this study employed Getis-Ord Gi* (d) statistics to ascertain statistically significant crash hotspots. Finally, maps generated through these two methods were assessed to determine statistically significant high-risk road segments. Moreover, temporal analysis of the crash pattern was performed using spider graphs to explore the variance throughout the day. Results: Within the Fort Peck Indian Reservation, some parts of the US highway 13, BIA Route 1, and US highway 2 are among the many segments being identified as high-risk road segments in this analysis. Also, although some residential roads have PDO crashes, they have been detected as high priority areas due to high crash occurrence. The temporal analysis revealed that crash patterns were almost similar on the weekdays reaching the peak at traffic peak hours, but during the weekend, crashes mostly occurred at midnight. Conclusion: The study would provide tribes with the tool to identify locations demanding immediate safety concerns. This study can be used as a template for other tribes to perform spatial and temporal analysis of the crash patterns to identify high risk crash locations on their roadways.

Annual Nationwide Infection Trends for Revision Total Knee Arthroplasty

2019 ◽  
Author(s):  
Peter Gold ◽  
Luke J. Garbarino ◽  
Nipun Sodhi ◽  
Hiba K. Anis ◽  
Joseph O. Ehiorobo ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
The United States ◽  
Revision Total Knee Arthroplasty ◽  
Wound Management ◽  
Improvement Program ◽  
Total Knee ◽  
Revision Tka

AbstractSeveral recent intraoperative and wound management techniques have been developed and implemented in the United States over the past decade; however, it is unclear what the effects of these newer modalities have on reducing surgical site infection (SSI) rates. Therefore, the purpose of this study was to track the annual rate and trends of (1) overall, (2) deep, and (3) superficial SSIs following revision total knee arthroplasty (TKA). The National Surgical Quality Improvement Program database was queried for all revision TKA cases performed between 2011 and 2016, which yielded 9,887 cases. Cases with superficial and/or deep SSIs were analyzed separately and then combined to evaluate overall SSI rates. After an overall 6-year correlation and trends analysis, univariate analysis was performed to compare the most recent year, 2016, with the preceding 5 years. Correlation coefficients and chi-square tests were used to determine correlation and statistical significance. No significant correlations between combined, deep, and/or superficial SSI rates and year were noted (p > 0.05). The lowest overall SSI incidence was in 2012 (1.16%), while the greatest incidence was in 2014 (1.76%). The deep SSI incidence over the 6 years was 0.67% (66 out of 9,887 cases). Deep SSI rate decreased by 10% in 2016 compared with 2011 (0.50 vs. 0.56%, p  > 0.05). In this 6-year period, 94 cases out of 9,887 were complicated by a superficial SSI, an incidence of 0.95%. The lowest superficial SSI incidence occurred in 2015 (n = 17, 0.77%). Overall, the incidence of SSIs in revision TKA has remained fairly low with some annual variance, indicating room for improvement. These variations likely as revision surgeries can be more complex and have several associated confounding factors influencing outcomes, when compared with primary cases. Further research is needed to identify revision-specific strategies to reduce the risk of surgical site infections.

scholarly journals The Early Experience With Vedolizumab in the United States

2019 ◽  
Vol 1 (3) ◽  
Author(s):  
Bharati Kochar ◽  
Yue Jiang ◽  
Aaron Winn ◽  
Edward L Barnes ◽  
Christopher F Martin ◽  
...  
Keyword(s):  
Population Level ◽  
Clinical Effectiveness ◽  
The United States ◽  
Steroid Use ◽  
Treatment Persistence ◽  
Serious Infections ◽  
Post Marketing ◽  
Multivariable Regression ◽  
Inflammatory Bowel ◽  
Multivariable Regression Models

Abstract Background Post-marketing studies of new inflammatory bowel disease (IBD) therapies are needed to establish clinical effectiveness and safety in clinical practice. We aimed to describe the U.S. experience with vedolizumab in a commercially insured population. Methods We conducted a retrospective cohort study in Quintiles-IMS Legacy PharMetrics Adjudicated Claims Database from May 2014 to June 2016. We included new vedolizumab users with Crohn disease (CD) and ulcerative colitis (UC) between 18 and 64 years with ≥12 months of continuous enrollment prior to initiating vedolizumab. Outcomes included treatment persistence &gt;14 weeks, late steroid use, IBD-related surgery and infections associated with hospitalization. We built multivariable regression models to identify predictors of treatment persistence and late steroid use. Results We identified 269 CD and 187 UC vedolizumab initiators. Only 60% of CD patients and 56% of UC patients remained on vedolizumab after 14 weeks without IBD-related hospitalization, surgery, and corticosteroid use. There were no significant predictors of treatment persistence. Steroid use in the first 2 months of vedolizumab initiation was a significant predictor of late steroid use in CD (odds ratio: 23.34; 95% confidence interval: 5.10–153.89). In the 6 months after vedolizumab initiation, 1.9% of CD and 5.9% of UC patients had an IBD-related surgery. Serious infections were &lt;4%. Conclusions These data reflect the early U.S. experience with vedolizumab. The population-level response to vedolizumab therapy is just &gt;50%. Steroids at the time of vedolizumab initiation is the strongest predictor of late steroid use in CD. Rates of surgery and serious infections are low.

Unanticipated Admission Following Outpatient Laparoscopic Cholecystectomy: Identifying Opportunities for Improvement

2020 ◽  
pp. 000313482095634
Author(s):  
Anna C. Beck ◽  
Paolo Goffredo ◽  
Xiang Gao ◽  
Patrick W. McGonagill ◽  
Ronald J. Weigel ◽  
...  
Keyword(s):  
Admission Rate ◽  
The United States ◽  
Improvement Program ◽  
Admission Rates ◽  
American College Of Surgeons ◽  
Cardiopulmonary Complications ◽  
Unanticipated Admission ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Retained Stones

Background Unanticipated admissions are a burden to the health care system. Over 400 000 outpatient laparoscopic cholecystectomies (LCs) are performed annually in the United States. The aim of this study is to identify causes of unanticipated admissions and modifiable risk factors. Methods Patients undergoing elective outpatient LCs were identified from the 2013-2015 American College of Surgeons National Surgical Quality Improvement Program database. Results A total of 69 376 patients underwent outpatient LC or LC+ intraoperative cholangiogram (IOC); 2027 (2.9%) were admitted after a median of 5 days (interquartile range 3-8). Admission rates varied by preoperative indications: pancreatitis (4.9%), gallstones with obstruction (3.9%), cholecystitis (3.0%), and gallstones without obstruction (2.6%) ( P = .003). The most frequent causes were infection, retained stones, and other GI complications. Patients admitted for infection or cardiopulmonary complications were older with higher American Society of Anesthesiologists (ASA) ( P < .01), while patients with pain and retained stones were younger with lower ASA ( P < .01). Patients who underwent LC+IOC had a lower admission rate due to retained stones (.17% vs. .31% LC, P = .006). Conclusions Unanticipated admissions following outpatient LC occur infrequently for diverse reasons usually within the first week after surgery. Associated factors are patient and disease related and not at all modifiable. In selected patients, increased IOC use may decrease admissions from retained stones.

Racial and Sex Disparities in Trauma Outcomes Based on Geographical Region

2020 ◽  
pp. 000313482096006
Author(s):  
William Q. Duong ◽  
Areg Grigorian ◽  
Cyrus Farzaneh ◽  
Jeffry Nahmias ◽  
Theresa Chin ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Trauma Patients ◽  
Improvement Program ◽  
Trauma Outcomes ◽  
Risk Of Death ◽  
Hospital Access ◽  
Risk Of Mortality ◽  
Sex Disparities ◽  
Male Patients

Objectives Disparities in outcomes among trauma patients have been shown to be associated with race and sex. The purpose of this study was to analyze racial and sex mortality disparities in different regions of the United States, hypothesizing that the risk of mortality among black and Asian trauma patients, compared to white trauma patients, will be similar within all regions in the United States. Methods The Trauma Quality Improvement Program (2010-2016) was queried for adult trauma patients, separating by U.S. Census regions. Multivariable logistic regression analyses were performed for each region, controlling for known predictors of morbidity and mortality in trauma. Results Most trauma patients were treated in the South (n = 522 388, 40.7%). After risk adjustment, black trauma patients had a higher associated risk of death in all regions, except the Northeast, compared to white trauma patients. The highest associated risk of death for blacks (vs. whites) was in the Midwest (odds ratio [OR] 1.30, P < .001). Asian trauma patients only had a higher associated risk of death in the West (OR 1.39, P < .001). Male trauma patients, compared to women, had an increased associated risk of mortality in all four regions. Discussion This study found major differences in outcomes among different races within different regions of the United States. There was also both an increased rate and associated risk of mortality for male patients in all regions. Future prospective studies are needed to identify what regional differences in trauma systems including population density, transport times, hospital access, and other trauma resources explain these findings.

scholarly journals The Epidemiology and Genetics of Hyperuricemia and Gout across Major Racial Groups: A Literature Review and Population Genetics Secondary Database Analysis

2021 ◽  
Vol 11 (3) ◽  
pp. 231
Author(s):  
Faven Butler ◽  
Ali Alghubayshi ◽  
Youssef Roman
Keyword(s):  
Literature Review ◽  
Risk Allele ◽  
Statistical Significance ◽  
Elevated Serum ◽  
The United States ◽  
Allele Frequencies ◽  
Racial Groups ◽  
1000 Genomes Project ◽  
1000 Genomes ◽  
Risk Alleles

Gout is an inflammatory condition caused by elevated serum urate (SU), a condition known as hyperuricemia (HU). Genetic variations, including single nucleotide polymorphisms (SNPs), can alter the function of urate transporters, leading to differential HU and gout prevalence across different populations. In the United States (U.S.), gout prevalence differentially affects certain racial groups. The objective of this proposed analysis is to compare the frequency of urate-related genetic risk alleles between Europeans (EUR) and the following major racial groups: Africans in Southwest U.S. (ASW), Han-Chinese (CHS), Japanese (JPT), and Mexican (MXL) from the 1000 Genomes Project. The Ensembl genome browser of the 1000 Genomes Project was used to conduct cross-population allele frequency comparisons of 11 SNPs across 11 genes, physiologically involved and significantly associated with SU levels and gout risk. Gene/SNP pairs included: ABCG2 (rs2231142), SLC2A9 (rs734553), SLC17A1 (rs1183201), SLC16A9 (rs1171614), GCKR (rs1260326), SLC22A11 (rs2078267), SLC22A12 (rs505802), INHBC (rs3741414), RREB1 (rs675209), PDZK1 (rs12129861), and NRXN2 (rs478607). Allele frequencies were compared to EUR using Chi-Square or Fisher’s Exact test, when appropriate. Bonferroni correction for multiple comparisons was used, with p < 0.0045 for statistical significance. Risk alleles were defined as the allele that is associated with baseline or higher HU and gout risks. The cumulative HU or gout risk allele index of the 11 SNPs was estimated for each population. The prevalence of HU and gout in U.S. and non-US populations was evaluated using published epidemiological data and literature review. Compared with EUR, the SNP frequencies of 7/11 in ASW, 9/11 in MXL, 9/11 JPT, and 11/11 CHS were significantly different. HU or gout risk allele indices were 5, 6, 9, and 11 in ASW, MXL, CHS, and JPT, respectively. Out of the 11 SNPs, the percentage of risk alleles in CHS and JPT was 100%. Compared to non-US populations, the prevalence of HU and gout appear to be higher in western world countries. Compared with EUR, CHS and JPT populations had the highest HU or gout risk allele frequencies, followed by MXL and ASW. These results suggest that individuals of Asian descent are at higher HU and gout risk, which may partly explain the nearly three-fold higher gout prevalence among Asians versus Caucasians in ambulatory care settings. Furthermore, gout remains a disease of developed countries with a marked global rising.

Thumb-Basal Joint Arthroplasty Outcomes and Metacarpal Subsidence: A Prospective Cohort Analysis of Trapeziectomy With Suture Button Suspensionplasty Versus Ligament Reconstruction With Tendon Interposition

Hand ◽  
2021 ◽  
pp. 155894472199422
Author(s):  
Owolabi Shonuga ◽  
Kristen Nicholson ◽  
Jack Abboudi ◽  
Gregory Gallant ◽  
Christopher Jones ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Demographic Data ◽  
Cohort Analysis ◽  
Joint Arthroplasty ◽  
Pinch Strength ◽  
Complication Rates ◽  
Suture Button ◽  
Basal Joint ◽  
Tendon Interposition ◽  
Cmc Joint

Background Thumb carpometacarpal (CMC) joint arthroplasty is a common procedure in the surgical management of symptomatic thumb basal joint arthritis. Following trapeziectomy, a number of suspensionplasty techniques are often used, but limited comparative evidence exists between these techniques. The central aim of this study was to prospectively compare the outcomes of 2 suspensionplasty techniques following trapeziectomy: suture button (TightRope) versus ligament reconstruction and tendon interposition (LRTI). Methods Prospective data were collected on 112 consecutive patients with Eaton stage III-IV thumb CMC arthritis who underwent open trapeziectomy and suspensionplasty. There were 53 LRTI and 59 TightRope suspensionplasty procedures. Outcomes were measured using the Quick Disabilities of the Arm, Shoulder, and Hand ( QuickDASH) questionnaire, Visual Analogue Scale (VAS) for pain, radiographic analysis, and lateral pinch strength. Patient demographic data and complications were also recorded. Results Patients undergoing TightRope suspensionplasty had significantly higher trapeziometacarpal index and thus less subsidence than the LRTI group at 2 weeks (0.22 vs 0.17 [ P < .0001]) and 3 months (0.17 vs 0.15 [ P < .05]) postoperatively. TightRope suspensionplasty also had a significantly lower QuickDASH score at 2 weeks (64.7 vs 74.6 [ P < .05]), 3 months (20.7 vs 32.5 [ P < .05]), and 1 year postoperatively (7.57 vs 21.5 [ P < .05]) compared with the LRTI group. However, there was no difference in VAS pain, lateral pinch strength, reoperation, or complications at any time point between groups. Conclusions Thumb CMC joint arthroplasty performed with a TightRope suspensionplasty versus LRTI yielded short-term improved resistance to subsidence, long-term greater improvement in clinical outcome by QuickDASH, and no difference in pain or complication rates.

Association of Hospital Safety Net Status With Outcomes and Resource Use for Extracorporeal Membrane Oxygenation in the United States

2021 ◽  
pp. 088506662110070
Author(s):  
Matthew Gandjian ◽  
Catherine Williamson ◽  
Yu Xia ◽  
Carlos Maturana ◽  
Nikhil Chervu ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Resource Use ◽  
Safety Net ◽  
The United States ◽  
Infectious Complications ◽  
Membrane Oxygenation ◽  
Hospital Safety ◽  
Hospitalization Costs ◽  
National Cohort ◽  
Multivariable Regression

Purpose: Safety net hospitals (SNH) have been associated with inferior surgical outcomes and increased resource use. Utilization and outcomes for extracorporeal membrane oxygenation (ECMO), a rescue modality for patients with respiratory or cardiac failure, may vary by safety net status. We hypothesized SNH to be associated with inferior outcomes and costs of ECMO in a national cohort. Materials and Methods: The 2008-2017 National Inpatient Sample was queried for ECMO hospitalizations and safety net hospitals were identified. Multivariable regression was used to perform risk-adjusted comparisons of mortality, complications and resource utilization at safety net and non-safety net hospitals. Results: Of 36,491 ECMO hospitalizations, 28.2% were at SNH. On adjusted comparison SNH was associated with increased odds of mortality (AOR: 1.23), tracheostomy use (AOR: 1.51), intracranial hemorrhage (AOR: 1.39), as well as infectious complications (AOR: 1.21, all P < .05), with NSNH as reference. SNH was also associated with increased hospitalization duration (β=+4.5 days) and hospitalization costs (β=+$32,880, all P < .01). Conclusions: We have found SNH to be associated with inferior survival, increased complications, and higher costs compared to NSNH. These disparate outcomes warrant further studies examining systemic and hospital-level factors that may impact outcomes and resource use of ECMO at SNH.

Comparison of simulated key pinch after three surgical procedures for trapeziometacarpal osteoarthritis: a cadaver study

2021 ◽  
pp. 175319342110159
Author(s):  
Lionel Athlani ◽  
Damien Motte ◽  
Marie Martel ◽  
Florent Moissenet ◽  
Julie Mottet ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Total Joint Arthroplasty ◽  
Ligament Reconstruction ◽  
Cadaver Study ◽  
Joint Arthroplasty ◽  
Pinch Force ◽  
Trapeziometacarpal Osteoarthritis ◽  
Intact Sample ◽  
Significant Difference ◽  
Tendon Interposition

We performed a cadaver study using 18 fresh-frozen adult forearms and hands to compare the tendon loads required to generate progressively greater key pinch (0.5 kg to 2 kg) after three different surgical procedures to treat trapeziometacarpal osteoarthritis: isolated trapeziectomy, trapeziectomy followed by ligament reconstruction with tendon interposition and total joint arthroplasty using a Touch® implant. Thumb pinch was simulated by loading the main actuator tendons involved in the key pinch. Six specimens were randomly assigned to each of the three surgical procedure groups. Measurements were made before and after the joint surgery. Specimens that underwent trapeziectomy with or without ligament reconstruction with tendon interposition required significantly higher tendon loads than those with the implant to achieve the same pinch force. There was no significant difference between the isolated trapeziectomy and ligament reconstruction groups. Using the implant resulted in similar median tendon loads compared with those of the intact sample. Total joint arthroplasty with a Touch® prosthesis may yield a superior biomechanical profile in which the tendon loads needed to achieve a certain key pinch force are lower and better distributed between the actuator muscles compared with trapeziectomy with or without ligament reconstruction.

scholarly journals Appendiceal adenocarcinoma found by surgery for acute appendicitis is associated with older age

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
John P. Skendelas ◽  
Victor S. Alemany ◽  
Vincent Au ◽  
Devika Rao ◽  
John McNelis ◽  
...  
Keyword(s):  
New York ◽  
Acute Appendicitis ◽  
Incidental Finding ◽  
Population Sample ◽  
Operative Therapy ◽  
Operative Management ◽  
The United States ◽  
Improvement Program ◽  
Common Procedure ◽  
Appendiceal Neoplasms

Abstract Background Appendectomy for acute appendicitis is the most common procedure performed emergently by general surgeons in the United States. The current management of acute appendicitis is increasingly controversial as non-operative management gains favor. Although rare, appendiceal neoplasms are often found as an incidental finding in the setting of appendectomy. Criteria and screening for appendiceal neoplasms are not standardized among surgical societies. Methods The National Surgical Quality Improvement Program (NSQIP) database was queried for all patients who underwent appendectomy over a 9-year period (2010–2018). Over the same time period, patients who underwent appendectomy in two municipal hospitals in The Bronx, New York City, USA were reviewed. Results We found a 1.7% incidence of appendiceal neoplasms locally and a 0.53% incidence of appendiceal tumors in a national population sample. Both groups demonstrated an increased incidence of appendiceal carcinoma by age. This finding was most pronounced after the age of 40 in both local and national populations. In our study, the incidence of appendiceal tumors increased with each decade interval up to the age of 80 and peaked at 2.1% in patients between 70 and 79 years. Conclusions Appendiceal adenocarcinomas were identified in patients with acute appendicitis that seem to be associated with increasing age. The presence of an appendiceal malignancy should be considered in the management of older patients with acute appendicitis before a decision to embark on non-operative therapy.

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