Scaphotrapeziotrapezoid Arthrodesis: A 10-Year Follow-up Study of Complications in 58 Wrists

Hand ◽  
2020 ◽  
pp. 155894472096497
Author(s):  
Miranda J. Rogers ◽  
Chao-Chin Lu ◽  
Andrew R. Stephens ◽  
Brittany N. Garcia ◽  
Wei Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Smoking History ◽  
Fixation Method ◽  
Veterans Health ◽  
Health Administration ◽  
Opioid Use ◽  
Factors Associated ◽  
Increased Risk ◽  
Stt Arthrodesis

Background: Scaphotrapeziotrapezoid (STT) arthrodesis is a procedure used for specific degenerative arthritis and instability patterns of the wrist. This study evaluates nonunion rate and risk factors for reoperation after STT arthrodesis in the Veterans Affairs Department patient population. The purpose of our study was to assess the long-term nonunion rate following STT arthrodesis and to identify factors associated with reoperation. Methods: The national Veterans Health Administration Corporate Data Warehouse and Current Procedural Terminology codes identified STT arthrodesis procedures from 1995 to 2016. Frequencies of total wrist arthrodesis (TWA) and secondary operations were determined. Univariate analyses provided odds ratios for risk factors associated with complications. Results: Fifty-eight STT arthrodeses were performed in 54 patients with a mean follow-up of 120 months. Kirschner wires (K-wires) were the most common fixation method (69%). Six wrists (10%) required secondary procedures: 5 TWAs and 1 revision STT arthrodesis. Four patients underwent additional procedures for nonunion (7%). Twenty-four patients required K-wire removal, 8 (14%) of these in the operating room, which were not included in regression analysis. Every increase in 1 year of age resulted in a 15% decrease in likelihood of reoperation (95% confidence interval: 0.77-0.93; P < .0001). Opioid use within 90 days before surgery ( P = 1.00), positive smoking history ( P = 1.00), race ( P = .30), comorbidity count ( P = .25), and body mass index ( P = .19) were not associated with increased risk of reoperation. Conclusions: At a mean follow-up of 10 years, patients undergoing STT arthrodesis have a 10% risk of reoperation, and this risk decreases with older patient age. There was a symptomatic nonunion rate of 7%, similar to prior published rates. Patient demographics, comorbidity, smoking history, and opioid use did not appear to increase risk of reoperation.

Factors associated with regression of cervical dysplasia in adolescents: A retrospective study

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5582-5582
Author(s):  
C. Chen ◽  
F. Campbell ◽  
J. Patruno ◽  
S. Kimmel ◽  
R. Boulay ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Pap Smear ◽  
Demographic Data ◽  
Cervical Dysplasia ◽  
Smoking History ◽  
Pap Smears ◽  
Factors Associated ◽  
Increased Risk ◽  
Chi Square Analysis

5582 Background: Sexually active adolescents have high rates of infection with human papilloma virus (HPV) and abnormal pap smears. They are considered a special population as they are likely to regress to normal cytology. The aim of our study was to identify factors associated with regression of cervical dysplasia in adolescents. Methods: We identified adolescent patients (aged 12–21 years) who had abnormal pap smears at the Center for Women's Medicine at Lehigh Valley Hospital in Allentown, PA, by CPT code from a database between Jan 2004 and Dec 2006. A chart review was performed to capture demographic data, cytology, smoking history, number of sexual partners, parity, race, contraceptive choice, use of barrier contraception. Chi-square analysis with logistic regression and multivariate analysis were used to identify factors associated with regression of cervical dysplasia. Results: Two-hundred two patients were identified. Mean age was 18.84 years (14–22 years). One hundred twenty-two (57.8%) were Hispanic, 71 (33.6%) Caucasian, and 16 (7.6%) Black. Fifty-two (24.6%) were pregnant at the time of diagnosis. Seventy-six (36%) were smokers. There were 125 (61.9%) cases of ASCUS, 33.7% (68 cases) LGSIL and 4.5% (9 cases) HGSIL on initial pap smear. One hundred eighteen (55.9%) patients had colposcopy, and of these, 32 (15.2%) had surgical intervention. Follow-up demonstrated that 72 (57.6%) patients had disease regression, 24 (19.2%) persistence and 29 (23.2%) progression. On multivariate analysis, patients who did not smoke were significantly more likely to show regression of cervical dysplasia on pap smear than women who smoked (OR 2.17, 95% CI 1.03–4.55, p = 0.039). Other factors were not statistically significant in predicting regression of cervical dysplasia. Conclusions: Adolescents who smoke were more likely to have persistent cervical dysplasia than non-smoking adolescents, putting smokers at an increased risk of advanced disease. We suggest that this subset have follow-up at shorter intervals and be enrolled in a smoking cessation program. No significant financial relationships to disclose.

Risk factors associated with a second primary lung cancer (SPLC) in patients (pts) with a previous initial primary lung cancer (IPLC).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e13166-e13166
Author(s):  
Misako Nagasaka ◽  
Dina Farhat ◽  
Kimberly Belzer ◽  
Seongho Kim ◽  
Hirva Mamdani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Family History ◽  
Surgical Resection ◽  
Tobacco Use ◽  
Primary Lung Cancer ◽  
Smoking History ◽  
Factors Associated ◽  
Increased Risk ◽  
First Diagnosis

e13166 Background: The risk for development of a SPLC after treatment of an IPLC is around 1% to 2% per pt per year. The aim of this study was to characterize the risk factors associated with the development of a SPLC. Methods: Pts registered in the Karmanos Cancer Institute Tumor Registry diagnosed with an IPLC between 2000 and 2017 were included in this study. Pts with an IPLC who later developed a SPLC were matched for age, histology and stage to pts with an IPLC who did not develop a SPLC. SPLC was defined as a second lung cancer with a different pathology or if the same pathology, anatomically, molecularly, or chronologically distinct. Six variables including: stage at IPLC, histology, family history, surgery as a primary treatment for IPLC, and smoking history (determined by pack years, and continued tobacco use after first diagnosis) were reviewed. Logistic and Cox regression analyses were performed to determine the relationship of these characteristics with the development of a SPLC, and their association with overall survival (OS). Results: 121 pts with IPLC who later developed an SPLC were identified and compared to 120 pts with IPLC who did not develop a SPLC. Logistic analyses did not show that stage at first diagnosis, histology, family history, smoking history, and continued tobacco use after first diagnosis to be relevant for increased risk of SPLC. Pts who were primarily treated with surgical resection had a significantly higher probability of developing a SPLC (Odds Ratio: 0.24, 95% CI: 0.12 to 0.48, p < 0.001). Pts who did not have surgical resection as their primary mode of treatment for IPLC had a significantly higher risk of death than those who received surgical resection (HR 3.02, 95% CI: 1.99 to 4.57; p < 0.001). Conclusions: Based on our findings, pts who had surgical resection for an IPLC were found to have improved OS and a higher possibility of developing a SPLC. Stage at first diagnosis of IPLC, histology, family history, smoking history and continued use of tobacco after first diagnosis did not correlate with increased risk for SPLC. These results warrant further investigation and if confirmed could have an impact on surveillance recommendations post resection of initial lung cancers.

scholarly journals Mild TBI and risk of Parkinson disease

Neurology ◽  
2018 ◽  
Vol 90 (20) ◽  
pp. e1771-e1779 ◽  
Author(s):  
Raquel C. Gardner ◽  
Amy L. Byers ◽  
Deborah E. Barnes ◽  
Yixia Li ◽  
John Boscardin ◽  
...  
Keyword(s):  
Brain Injury ◽  
Parkinson Disease ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Mild Tbi ◽  
Psychiatric Comorbidities ◽  
Increased Risk ◽  
Severe Tbi

ObjectiveOur aim was to assess risk of Parkinson disease (PD) following traumatic brain injury (TBI), including specifically mild TBI (mTBI), among care recipients in the Veterans Health Administration.MethodsIn this retrospective cohort study, we identified all patients with a TBI diagnosis in Veterans Health Administration databases from October 2002 to September 2014 and age-matched 1:1 to a random sample of patients without TBI. All patients were aged 18 years and older without PD or dementia at baseline. TBI exposure and severity were determined via detailed clinical assessments or ICD-9 codes using Department of Defense and Defense and Veterans Brain Injury Center criteria. Baseline comorbidities and incident PD more than 1 year post-TBI were identified using ICD-9 codes. Risk of PD after TBI was assessed using Cox proportional hazard models adjusted for demographics and medical/psychiatric comorbidities.ResultsAmong 325,870 patients (half with TBI; average age 47.9 ± 17.4 years; average follow-up 4.6 years), 1,462 were diagnosed with PD during follow-up. Compared to no TBI, those with TBI had higher incidence of PD (no TBI 0.31%, all-severity TBI 0.58%, mTBI 0.47%, moderate-severe TBI 0.75%). In adjusted models, all-severity TBI, mTBI, and moderate-severe TBI were associated with increased risk of PD (hazard ratio [95% confidence interval]: all-severity TBI 1.71 [1.53–1.92]; mTBI 1.56 [1.35–1.80]; moderate-severe TBI 1.83 [1.61–2.07]).ConclusionsAmong military veterans, mTBI is associated with 56% increased risk of PD, even after adjusting for demographics and medical/psychiatric comorbidities. This study highlights the importance of TBI prevention, long-term follow-up of TBI-exposed veterans, and the need to determine mechanisms and modifiable risk factors for post-TBI PD.

scholarly journals Follicular Lymphoma Frontline Immuno-Chemotherapy: Survival Outcomes and Infection-Related Morbidity

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5884-5884
Author(s):  
Faouzi Djebbari ◽  
Furqaan Kaji ◽  
Louise Stanton ◽  
Graham P. Collins ◽  
Toby A. Eyre
Keyword(s):  
Follicular Lymphoma ◽  
Progression Free Survival ◽  
Continuous Variable ◽  
Smoking History ◽  
Factors Associated ◽  
Increased Risk ◽  
Potential Factors ◽  
Conference Attendance ◽  
Anti Cd20

Background Follicular lymphoma (FL) patients (pts) receiving immunochemotherapy now have a median overall survival (OS) of 15-20 years (y). ~80% of pts demonstrate an age/sex-matched OS compared to the population (Casulo et al, 2015). As such, optimizing therapy and minimizing toxicities are key outcome measures. The GALLIUM trial (Marcus et al, 2017) reported excess toxicity with front line (1L) obinutuzumab (O) compared to rituximab (R) (neutropenic fever, infection) and with bendamustine (B) (treated-related mortality ~4-5%). Methods We performed a single institution retrospective analysis of 132 consecutively 1L FL pts (2009-19) to assess factors associated with progression-free survival (PFS), OS, and morbidity following chemotherapy (R or O with CVP, CHOP, or B) +/- anti-CD20 antibody (ab) maintenance. Transformed FL was excluded. We collected data on all-cause infection over a 3y period, including infective-related admissions and grade (G) 1-2 infections regardless if they received maintenance. Univariable (UVA) and multivariable analyses (MVA) assessed factors for infective complications. Potential factors included were: age, baseline Hb (<12), CIRS-G, CIRS-G severity (CIRS-G/number of comorbidities), FLIPI, smoking history, COPD, immunochemotherapy, and maintenance. Results Across all pts, the median age was 63 y (range 28-90). Time from diagnosis to 1L was 1.6 months (range 0.03-110). Regimens included R-CHOP (n=34), R-CVP (n=53), R-B (n=32), O-B (n=9). B-treated pts were younger (median 57 y) than R-CHOP (median 62 y) and R-CVP (median 71 y). The mean CIRS-G (R-CHOP 1.38 vs R-CVP 2.76 vs B-R 1.1) and CIRS-G severity score (R-CHOP 0.81 vs R-CVP 1.38 vs R-B 0.81) were both higher in R-CVP pts. R-CVP pts had lower FLIPI scores (FLIPI 3-5: B-R/O 71%, R-CHOP 68%, R-CVP 55%). 68% R-CHOP, 51% R-CVP and 76% B-R/O of pts started anti-CD20 ab maintenance. The 3y PFS was 70% (95% confidence interval (CI) 61-78%) (Fig A) and 3y OS 89% (95% CI 82-93%) (Fig B) across all pts. Pts receiving R-CVP had an inferior PFS (Fig C) than RCHOP or B-R/O (3y PFS 52% (95% CI 37-66%) vs R-CHOP 3y PFS: 82% (95% CI 63-92%) vs BR 88% (95% 70-95%) vs B-O 63% (CI 24-87%) p=0.004). This translated to R-CVP pts having an inferior OS (Fig D) compared to RCHOP or B-R/O (3y OS 82% (95% CI 68-90%) vs R-CHOP 100% vs BR 91% (95% 74-97%) vs B-O 88% (95% CI 39-98%) p=0.006); reflecting both pt characteristics and treatment efficacy. Across all pts, the 3y PFS was 81% (95% CI 70-89%) with anti-CD20 ab maintenance versus 53% (95% CI 37-66%) without maintenance (p=0.001) (Fig E). There was an OS difference in favour of maintenance (3y OS 75% vs 97%) (p=0.012) (Fig F). There were 74 documented infective episodes (G1+) across all pts over 3y follow up. There were 43 infective-related admissions (G3+) during induction (n=132) and 16 during maintenance (n=83). The highest numerical risk of any infective episode(s) within 3 y follow up was BR (69% 22/32) and lowest R-CVP (50% 25/50) (p=0.09). G3+ infection during induction was significantly higher with R-CHOP (52% 17/33) compared to BR 6/32 (19% 6/32) (p=0.006). Conversely during maintenance, infective-related admissions were numerically higher in B-treated (R+O) (23% 7/31) compared to RCVP/RCHOP pts (16% 8/50) (p=0.46). Factors associated with an increased risk for all grade infections by UVA included: maintenance (odds ratio (OR): 2.1 (95% CI 1-4.4), p=0.05), CIRS-G* (OR: 1.2 (95% CI 1-4.4), p=0.07), CIRS-G severity* (OR: 1.5 (1.0-2.2) p=0.04). On MVA, the only risk factor for all grade infective episodes (ref: R-CVP) was BR (OR 3.8 (95% CI 1.2-11.6); p=0.02). Factors associated with an increased infective-related admission by UVA included high CIRS-G* (OR:1.15 (95% CI 1-4.4), p=0.09). On MVA, the factors of significance for an increased infective admissions were CIRS-G* (OR 1.34 (95% CI 1.0-1.8) and R-CHOP (ref: R-CVP OR:1.0) OR 3.2 (95% CI 1.1-9.1); p=0.03). Conclusions OS and PFS were superior in pts receiving R-CHOP or B-based treatment compared to R-CVP. Similarly, superior OS and PFS were seen in pts receiving anti-CD20 maintenance. Consistent with GALLIUM, we show the risk of infective-related episodes across 3 y following bendamustine when accounting for other factors. Careful anti-infective measures (anti-viral, anti-PCP) are required following B-based therapy, including on maintenance. Infective-related admissions (G3+) were independently associated with R-CHOP. *continuous variable Disclosures Djebbari: Takeda: Honoraria, Other: support with conference attendance; Novartis: Honoraria; Celgene: Honoraria, Other: support with conference attendance, Research Funding; Amgen: Honoraria. Collins:Gilead: Consultancy, Honoraria. Eyre:Roche: Honoraria; Gilead: Consultancy, Honoraria, Other: commercial research support; Janssen: Honoraria; Abbvie: Honoraria.

scholarly journals Injuries associated with long working hours among employees in the US mining industry: risk factors and adverse outcomes

2019 ◽  
Vol 76 (6) ◽  
pp. 389-395 ◽  
Author(s):  
Lee S Friedman ◽  
Kirsten S Almberg ◽  
Robert A Cohen
Keyword(s):  
Risk Factors ◽  
Mining Industry ◽  
Working Hours ◽  
Mine Safety ◽  
Health Administration ◽  
Long Working Hours ◽  
Factors Associated ◽  
Multiple Injured ◽  
Increased Risk ◽  
Working Hour

ObjectivesThe mining industry is increasingly adopting extended workdays of 10–12 hour shifts. Studies demonstrate that long work hours are associated with psychomotor impairments caused by fatigue and an increased risk of injury. However, studies involving miners remain limited. This analysis aimed to identify risk factors associated with long working hour injuries and to determine if long working hour incidents were associated with being killed or incidents involving multiple injured workers.MethodsData from US Mine Safety and Health Administration Part 50 reports, 1983–2015, were used to identify long working hour injuries, which were defined as incidents occurring nine or more hours after the start of a shift.ResultsA total of 52 206 injuries (9.6%) occurred during long working hours. The proportion of long working hour injuries increased from 5.5% of all injuries in 1983 to its peak in 2015 at 13.9% (p<0.001). Risk factors associated with long working hour injuries included irregular shift starts, being newly employed, employment by a contractor, metal/non-metal operations and mines with <100 employees. In two separate adjusted models, long working hour injuries were associated with a higher odds of death (adjusted OR [aOR]=1.32; 95% CI 1.18 to 1.48) and single incidents resulting in two or more workers injured (aOR=1.73; 95% CI 1.58 to 1.89).ConclusionsLong working hour injuries were associated with a lack of routine, being new at the mine and specific mining activities. An international shift towards using contract labour and extended workdays indicates that injuries during long working hours will likely continue to grow as a problem in the mining industry.

Symptomatic Venous Thromboembolism After Achilles Tendon Rupture: A Nationwide Danish Cohort Study of 28,546 Patients With Achilles Tendon Rupture

2019 ◽  
Vol 47 (13) ◽  
pp. 3229-3237 ◽  
Author(s):  
Melissa Hornbæk Pedersen ◽  
Liv Riisager Wahlsten ◽  
Henrik Grønborg ◽  
Gunnar Hilmar Gislason ◽  
Michael Mørk Petersen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Nonoperative Treatment ◽  
Incidence Rates ◽  
Factors Associated ◽  
Increased Risk ◽  
Male Sex

Background: Venous thromboembolism (VTE) is a well-known complication of Achilles tendon rupture (ATR) and carries a high risk of morbidity and mortality. Although routine thromboprophylaxis for patients with ATR is not recommended, sparse knowledge is available regarding risk factors associated with VTE in patients with ATR. Purpose: To use Danish nationwide registers to identify incidence rates for symptomatic VTE and risk factors associated with increased risk of developing VTE in patients with ATR. Study Design: Cohort study; Level of evidence, 3. Methods: By crosslinking nationwide registers, we identified all patients with diagnosed ATR in Denmark from 1997 to 2015. We stratified patients into 4 groups by age and treatment modality (ie, operative vs nonoperative treatment). The main outcome was VTE within 180 days. We calculated crude incidence rates and considered age, sex, year, comorbidities, and medications as risk factors for VTE in Poisson regression models. Results: We identified 28,546 patients with ATR, of whom 389 (1.36%) were hospitalized with VTE during the follow-up period: 278 due to deep vein thromboses and 138 due to pulmonary embolism. Incidence rates were highest during the first month and ranged from 4.6 to 14.6 events per 100 person-years. VTEs were most frequent among nonoperatively treated patients aged ≥50 years. In Poisson regression analyses, having had VTE beforehand was associated with an increased risk of VTE, as was male sex in the nonoperative treatment group aged ≥50 years; among women <50 years of age, hormonal contraceptives led to a 4- to 6-fold higher risk of VTE compared with patients in the same group without the equivalent risk factor. Conclusion: In this nationwide cohort of patients with ATR, 1.36% developed symptomatic VTE during follow-up. Hormonal contraception, previous VTE, older age group, and male sex increased the risk of VTE. Taken together, the results of the present study suggest that focus on risk stratification and initiatives to prevent VTE might be warranted. A randomized controlled trial could answer this question.

scholarly journals Military-related risk factors in female veterans and risk of dementia

Neurology ◽  
2018 ◽  
Vol 92 (3) ◽  
pp. e205-e211 ◽  
Author(s):  
Kristine Yaffe ◽  
Sandy J. Lwi ◽  
Tina D. Hoang ◽  
Feng Xia ◽  
Deborah E. Barnes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Proportional Hazards ◽  
The United States ◽  
Female Veterans ◽  
Veterans Health ◽  
Medical Conditions ◽  
Health Administration ◽  
Risk Of Death ◽  
Related Risk

ObjectiveTo determine whether diagnoses of traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and depression, alone or in combination, increase dementia risk among older female veterans.MethodsThis cohort study included data from 109,140 female veterans ≥55 years of age receiving care from Veterans Health Administration medical centers in the United States between October 2004 and September 2015 with at least 1 follow-up visit. TBI, PTSD, depression, and medical conditions at study baseline and incident dementia were determined according to ICD-9-CM codes. Fine-Gray proportional hazards models were used to determine the association between military-related risk factors and dementia diagnosis, accounting for the competing risk of death.ResultsDuring follow-up (mean 4.0 years, SD 2.3), 4% of female veterans (n = 4,125) developed dementia. After adjustment for demographics and medical conditions, women with TBI, PTSD, and depression had a significant increase in risk of developing dementia compared to women without these diagnoses (TBI-adjusted subdistribution hazard ratio [adjusted sHR] 1.49, 95% confidence interval [CI] 1.01–2.20; PTSD adjusted sHR 1.78, 95% CI 1.34–2.36; and depression-adjusted sHR 1.67, 95% CI 1.55–1.80), while women with >1 diagnosis had the highest risk for dementia (adjusted sHR 2.15, 95% CI 1.84–2.51).ConclusionsWe found that women with military-related risk factors had an ≈50% to 80% increase in developing dementia relative to women without these diagnoses, while female veterans with multiple risk factors had a >2-fold risk of developing dementia. These findings highlight the need for increased screening of TBI, PTSD, and depression in older women, especially female veterans.

The association of opioid use duration and new depression episode among patients with and without insomnia

2020 ◽  
Vol 16 (5) ◽  
pp. 317-328
Author(s):  
Joanne Salas, MPH ◽  
Mary Beth Miller, PhD ◽  
Jeffrey F. Scherrer, PhD ◽  
Rachel Moore, MS ◽  
Christina S. McCrae, PhD ◽  
...  
Keyword(s):  
Propensity Scores ◽  
Opioid Analgesic ◽  
Opioid Therapy ◽  
Veterans Health ◽  
Health Administration ◽  
Opioid Use ◽  
Specific Effects ◽  
Cox Proportional Hazard Models ◽  
Opioid Users

Objective: Insomnia commonly co-occurs with depression, chronic pain, and opioid use. Both insomnia and chronic opioid analgesic use (OAU) are independent risk factors for a new depression episode (NDE). This study determined if the association between longer OAU duration and NDE was stronger in those with versus without insomnia.Design: Retrospective cohort.Setting: Veterans Health Administration electronic medical records (2000-2012).Participants: New opioid users in follow-up (2002-2012), free of depression for two years prior to follow-up, and aged 18-80 (n = 70,997).Methods: NDE was ≥ 2 ICD-9 codes in a 12-month period. Insomnia before OAU initiation was ≥1 ICD-9 code. Cox proportional hazard models stratified on insomnia assessed the relationship between initiating a 1-30, 31-90, or 90 day period of OAU and NDE while controlling for confounders using inverse probability of treatment-weighted propensity scores (PS).Results: Compared to 1-30 day OAU, 31-90 day was associated with NDE in those without (HR = 1.20; 95 percent CI: 1.12-1.28) but not with insomnia (HR = 1.06; 95 percent CI: 0.86-1.32). Results showed a stronger effect of chronic (90) OAU in those with insomnia (HR = 1.59; 95 percent CI: 1.27-1.98) compared to those without (HR = 1.31; 95 percent CI: 1.21-1.42). However, all stratum-specific effects were not significantly different (p = 0.136).Conclusions: Although stratum-specific risks were statistically similar, there was evidence for a trend that chronic OAU is a stronger risk factor for NDE in those with versus without insomnia. Providers are encouraged to monitor sleep impairment among patients on opioid therapy, as sleep may be associated with greater risk for NDE in patients with chronic OAU. 

scholarly journals Oral Estrogen, Thromboembolic Events and Cardiometabolic Risk in Older vs. Younger Transgender Women Veterans

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A793-A793
Author(s):  
Sean J Iwamoto ◽  
Marnie T Janson ◽  
Laura K Grau ◽  
Samantha C Roberts ◽  
Troy A Moore ◽  
...  
Keyword(s):  
Risk Factors ◽  
Age Groups ◽  
Women Veterans ◽  
Transgender Women ◽  
Smoking History ◽  
Veterans Health ◽  
Health Administration ◽  
Exact Tests ◽  
Chi Square ◽  
Few Data

Abstract Data support increases in absolute thromboembolic event (TE) risk and worsening of cardiometabolic (CM) risk factors associated with estrogen (E)-based feminizing gender-affirming hormone therapy (GAHT). Few data exist comparing age, E type and CM risk in transgender women (TW) veterans. We conducted a retrospective analysis in TW prescribed E through our local Veterans Health Administration (VHA) between 2014-2019. Rates of TE (venous and arterial) and CM risk factors (hypertension [HTN], hyperlipidemia [HLD], type 2 diabetes mellitus [T2DM], obesity and smoking) were stratified by age (&lt;45 vs. ≥45 years) and oral vs. never-oral E therapy and compared using Fisher’s Exact Tests. We also compared TW rates with those of local men (N=77,514) and women (N=11,918) veterans using Chi-Square and Fisher’s Exact tests. Of 226 veterans with gender dysphoria, 130 identified as TW and 100 used VHA-prescribed E (&lt;45 years: N=54, ≥45 years: N=46). Only 9 TW (9%) had a history of TE (55.6% venous: 4 deep venous thrombosis +/- pulmonary embolism, 1 superficial thrombophlebitis; 44.4% arterial: 2 myocardial infarction, 2 ischemic stroke). Of the 7 TW with documented age at TE (median: 67 years, range: 33-80) and duration of E prior to TE (median: 5 years, range: 0-22), 4 were on E at the time of TE (2 oral estradiol, 1 conjugated Es, 1 injectable), 2 discontinued E 1-2 years prior to TE, and 1 unknown. Age and HTN were predictors of TE (P&lt;0.01) in univariate logistic regressions. Smoking history, body mass index (BMI) and oral E were not. Odds of TE were 10% higher (95% CI: 2-19%; P&lt;0.05) for every 1-year of any E therapy and 9% higher (95% CI: 3-16%; P&lt;0.01) for every 1-year increase in age at E initiation. TW ≥45 years had higher rates of CM risk including T2DM, 23.9%, HTN, 52.2%, and HLD, 54.3%, than TW &lt;45 years (5.6%, 16.7% and 20.4%, respectively). Obesity rates were similar between age groups (&lt;45 years: 53.7%; ≥45 years: 52.2%). Among TW with oral E, obesity rates were also similar between age groups (&lt;45 years: 54.5%; ≥45 years: 51.4%). Increased levels of LDL-cholesterol, triglycerides, systolic blood pressure (BP), diastolic BP and BMI were observed after any E initiation (P&lt;0.001). These increases remained significant after adjusting for time elapsed between pre-hormone and highest post-hormone values, age at initiation and oral E therapy. In addition, rates of HTN, HLD, obesity and smoking were significantly higher for TW compared to men and women in age-stratified analyses. TW &lt;45 years had a higher rate of T2DM than women (P=0.04) of the same age. TW ≥45 years had higher rates of arterial TE compared to men (p&lt;0.001) and women (P&lt;0.001), and higher rates of venous TE (P=0.02) and T2DM (P=0.01) compared women of the same age. In TW, absolute TE risk was low, but GAHT increased CM risk factors regardless of age and oral E use. Clinicians should consider these findings when discussing risks and benefits of E-based GAHT with TW veterans.

Four-Corner Arthrodesis versus Proximal Row Carpectomy: Risk Factors and Complications Associated with Prolonged Postoperative Opioid Use

2020 ◽  
Author(s):  
Neill Y. Li ◽  
Alexander S. Kuczmarski ◽  
Andrew M. Hresko ◽  
Avi D. Goodman ◽  
Joseph A. Gil ◽  
...  
Keyword(s):  
Risk Factors ◽  
International Classification Of Diseases ◽  
Opioid Use ◽  
Proximal Row Carpectomy ◽  
Use Patterns ◽  
Patient Demographics ◽  
Implant Complications ◽  
Increased Risk ◽  
Classification Of Diseases

Abstract Introduction This article compares opioid use patterns following four-corner arthrodesis (FCA) and proximal row carpectomy (PRC) and identifies risk factors and complications associated with prolonged opioid consumption. Materials and Methods The PearlDiver Research Program was used to identify patients undergoing primary FCA (Current Procedural Terminology [CPT] codes 25820, 25825) or PRC (CPT 25215) from 2007 to 2017. Patient demographics, comorbidities, perioperative opioid use, and postoperative complications were assessed. Opioids were identified through generic drug codes while complications were defined by International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification codes. Multivariable logistic regressions were performed with p < 0.05 considered statistically significant. Results A total of 888 patients underwent FCA and 835 underwent PRC. Three months postoperatively, more FCA patients (18.0%) continued to use opioids than PRC patients (14.7%) (p = 0.033). Preoperative opioid use was the strongest risk factor for prolonged opioid use for both FCA (odds ratio [OR]: 4.91; p < 0.001) and PRC (OR: 6.33; p < 0.001). Prolonged opioid use was associated with an increased risk of implant complications (OR: 4.96; p < 0.001) and conversion to total wrist arthrodesis (OR: 3.55; p < 0.001) following FCA. Conclusion Prolonged postoperative opioid use is more frequent in patients undergoing FCA than PRC. Understanding the prevalence, risk factors, and complications associated with prolonged postoperative opioid use after these procedures may help physicians counsel patients and implement opioid minimization strategies preoperatively.

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