Preoperative Depression is Associated With Increased Complications Following Ankle Fracture Surgery

2022 ◽  
pp. 193864002110659
Author(s):  
Matthew S. Broggi ◽  
Syed Tahmid ◽  
John Hurt ◽  
Rishin J. Kadakia ◽  
Jason T. Bariteau ◽  
...  

Background The effects of preoperative depression following ankle fracture surgery remains unknown. The purpose of this study is to investigate the relationship between preoperative depression and outcomes following ankle fracture surgery. Methods This retrospective study used the Truven MarketScan database to identify patients who underwent ankle fracture surgery from January 2009 to December 2018. Patients with and without a diagnosis of preoperative depression were identified based on International Classification of Diseases (ICD) codes. Chi-squared and multivariate analyses were performed to determine the association between preoperative depression and postoperative complications following ankle fracture surgery. Results In total, 107,897 patients were identified for analysis, 13,981 of whom were diagnosed with depression (13%). Preoperative depression was associated with the increased odds for postoperative infection (odds ratio [OR]: 1.33, confidence interval [CI]: 1.20-1.46), wound complications (OR: 1.13, CI: 1.00-1.28), pain-related postoperative emergency department visits (OR: 1.58, CI: 1.30-19.1), 30-day and 90-day readmissions (OR: 1.08, CI: 1.03-1.21 and OR: 1.13, CI: 1.07-1.18), sepsis (OR: 1.39, CI: 1.12-1.72), and postoperative development of complex regional pain syndrome (OR: 1.46, CI: 1.18-1.81). Conclusion Preoperative depression is associated with increased complications following ankle fracture surgery. Further studies are warranted to investigate the degree to which depression is a modifiable risk factor. Level of Evidence: 3

2018 ◽  
Vol 39 (11) ◽  
pp. 1283-1289
Author(s):  
Young Hwan Park ◽  
Jong Hyub Song ◽  
Gi Won Choi ◽  
Hak Jun Kim

Background: Multiple options are available for closure of incisions in ankle fracture surgery. The aim of our study was to compare postoperative outcomes between conventional simple interrupted nylon sutures and 2-octyl cyanoacrylate as a topical skin adhesive to close the incision after ankle fracture surgery. Methods: We retrospectively reviewed the records of 367 consecutive patients (174 simple interrupted nylon suture patients and 193 topical skin adhesive patients) who underwent operative treatment for ankle fracture between 2010 and 2015. Development of wound complications, operative time, Olerud–Molander Ankle Score (OMAS), and patient satisfaction with the wound were compared. The demographics between the 2 groups were not different. Results: There were no differences in complication rates ( P = .861), OMAS at 3 months or 12 months following surgery ( P = .897 and .646, respectively) between the 2 types of wound closure. Operative time was 9 minutes shorter when topical skin adhesive was used compared to nylon sutures ( P = .003). Patient satisfaction with their wound was significantly higher in the topical skin adhesive group than the nylon skin suture group ( P = .012). Conclusions: The use of 2-octyl cyanoacrylate topical skin adhesive for wound closure following ankle fracture surgery was effective, safe, and showed higher patient satisfaction compared to simple interrupted nylon sutures. Although caution should be taken because of the insufficient statistical power of complications, this method was an additional safe option for wound closure in ankle fracture surgery. Level of Evidence: Level III, retrospective comparative study.


2018 ◽  
Vol 12 (5) ◽  
pp. 409-417 ◽  
Author(s):  
Hesham Saleh ◽  
Sanjit Konda ◽  
Adam Driesman ◽  
John Stranix ◽  
Catherine Ly ◽  
...  

Background. The incidence and risk factors of wound-healing complications following rotational ankle fracture surgery are well documented in the literature. However, there is a paucity regarding management options following these complications. The goal of this study was to provide a descriptive analysis of one surgeon’s experience managing wound complications in patients who have undergone ankle fracture surgery. Methods. A total of 215 patients who were operatively treated for an unstable ankle were retrospectively identified. Patient demographics, medical histories, initial injury characteristics, surgical interventions, and clinical follow-up were collected. Twenty-five of these patients developed postoperative wound problems. Results. Of the original cohort of 215 patients, 25 (11.6%) developed wound-healing complications. Their average age was 53.6 ± 18.0 years; there were 12 males (48.0%). Connective tissue/inflammatory disease (odds ratio [OR] 3.9), cardiovascular disease (OR 3.6), and active smoking (OR 3.3) were associated with an increased likelihood of developing postoperative wound complications. With regard to injuries, open fractures (OR 17.9) had the highest likelihood of developing postoperative complications, followed by type 44-C (OR 2.8) and trimalleolar fractures (OR 2.0). Conclusion. Wound complications following open treatment of ankle fractures occurred with an incidence of 11.6% in this series, of which only about half required operative intervention. A third of wounds were managed by orthopaedics in conjunction with plastic surgery. Levels of Evidence: Level III: Retrospective comparative study


2018 ◽  
Vol 40 (2) ◽  
pp. 218-223 ◽  
Author(s):  
Mostafa M. Abousayed ◽  
Christopher K. Johnson ◽  
Muhammad Moral ◽  
Sarah Sternbach ◽  
Andrew J. Rosenbaum

Background: The Centers for Medicare and Medicaid services (CMS) have implemented initiatives to improve postdischarge care and reduce unnecessary readmissions. Readmissions within 30 days are frequent and represent an economic burden on both patients and the healthcare system. The aim of this study was to evaluate the frequency and causes for urgent care visits within 30 days of discharge after ankle open reduction and internal fixation (ORIF) and determine factors correlated with such visits. Methods: This was a retrospective analysis of prospectively collected data. All patients who underwent ankle ORIF at our institution between July 1, 2016, and June 30, 2017, were included. Patients were identified using Current Procedural Terminology (CPT) codes for ankle ORIF. Patients’ demographics including age, sex, race, body mass index, occupation, insurance payer, and comorbidities were documented. Results: Thirty-five patients (10.51%) had urgent care visits within 30 days of discharge. Patients presented at a mean of 11.8 days after the day of surgery. Sixteen patients (45.71%) had cast/splint-related issues, 7 (20%) presented with pain, and 7 (20%) with increased operative site drainage. Univariate analysis demonstrated a statistically significant association between postoperative urgent care visits and patients with diabetes ( P = .03) or underlying psychiatric disorders ( P = .03). Conclusion: In this population study of patients undergoing ankle fracture surgery, we found that the rate of urgent care visits within 30 days of discharge exceeded the rate of inpatient readmission. Additionally, patients with diabetes and psychiatric disorders were significantly more likely to present to an urgent care facility postoperatively, potentially accounting for increased expenditures of the healthcare system. Level of Evidence: Level III, comparative series.


2017 ◽  
Vol 42 (7) ◽  
pp. 673-677 ◽  
Author(s):  
J. Nordenskjöld ◽  
M. Englund ◽  
C. Zhou ◽  
I. Atroshi

The prevalence and incidence of doctor-diagnosed Dupuytren’s disease in the general population is unknown. From the healthcare register for Skåne region (population 1.3 million) in southern Sweden, we identified all residents aged ⩾20 years (on 31 December 2013), who 1998 to 2013 had consulted a doctor and received the diagnosis Dupuytren’s disease (International Classification of Diseases 10th Revision code M720). During the 16 years, 7207 current residents (72% men) had been diagnosed with Dupuytren’s disease; the prevalence among men was 1.35% and among women 0.5%. Of all people diagnosed, 56% had received treatment (87% fasciectomy). In 2013, the incidence of first-time doctor-diagnosed Dupuytren’s disease among men was 14 and among women five per 10,000. The annual incidence among men aged ⩾50 years was 27 per 10,000. Clinically important Dupuytren’s disease is common in the general population. Level of evidence: III


2016 ◽  
Vol 33 (S1) ◽  
pp. S363-S364
Author(s):  
Á. López Díaz ◽  
A. Soler Iborte ◽  
S. Galiano Rus ◽  
J.L. Fernández González ◽  
J.I. Aznarte López

IntroductionThe term, acute and transient psychosis, is comprehended as a heterogeneous group of disorders, which share, as a common feature, the abrupt and brief deployment of typical psychotic behaviour, either polymorph, delusional, or schizophreniform. This diversity of symptoms may also be present in other psychotic disorders, for which, some authors question its reliability.ObjetiveTo analyse the clinical manifestations present in acute and transient psychotic disorders (ATPD), and determine the differences between its different subcategories.MethodRetrospective chart review study of adult patients admitted in our psychiatric unit between 2011 and 2015, with a mean diagnosis of ATPD at hospital discharge. Diagnostic criteria was according to the International Classification of Diseases (ICD-10). Symptoms were divided under operative procedures, as set out in psychopatologic descriptions. For methodological reasons, statistical analysis was conducted between polymorphic features group (PM) and nonpolymorphic group (NPM). Chi-squared test and Fisher's exact test (as appropriate) were performed, using MedCalc software.ResultsThirty-nine patients met the inclusion criteria. Acute polymorphic psychotic disorder with and without symptoms of schizophrenia (39%), acute schizophrenia-like psychotic disorder (20%), acute predominantly delusional psychotic disorder (23%), other and NOS (18%). There were statistically significant differences between PM and NPM groups in emotional turmoil (>PM, P = 0.0006), grossly disorganized or abnormal motor behaviour (>PM, P = 0.0038), and type of onset (sudden >PM, P = 0.0145).ConclusionCurrently, the same concept encompasses two categories (PM and NPM) to be differentiated. The ATPD construct is under review, due its long-term instability.Disclosure of interestThe authors have not supplied their declaration of competing interest.


Rheumatology ◽  
2020 ◽  
Vol 59 (12) ◽  
pp. 3759-3766 ◽  
Author(s):  
Sicong Huang ◽  
Jie Huang ◽  
Tianrun Cai ◽  
Kumar P Dahal ◽  
Andrew Cagan ◽  
...  

Abstract Objective The objective of this study was to compare the performance of an RA algorithm developed and trained in 2010 utilizing natural language processing and machine learning, using updated data containing ICD10, new RA treatments, and a new electronic medical records (EMR) system. Methods We extracted data from subjects with ≥1 RA International Classification of Diseases (ICD) codes from the EMR of two large academic centres to create a data mart. Gold standard RA cases were identified from reviewing a random 200 subjects from the data mart, and a random 100 subjects who only have RA ICD10 codes. We compared the performance of the following algorithms using the original 2010 data with updated data: (i) a published 2010 RA algorithm; (ii) updated algorithm, incorporating ICD10 RA codes and new DMARDs; and (iii) published algorithm using ICD codes only, ICD RA code ≥3. Results The gold standard RA cases had mean age 65.5 years, 78.7% female, 74.1% RF or antibodies to cyclic citrullinated peptide (anti-CCP) positive. The positive predictive value (PPV) for ≥3 RA ICD was 54%, compared with 56% in 2010. At a specificity of 95%, the PPV of the 2010 algorithm and the updated version were both 91%, compared with 94% (95% CI: 91, 96%) in 2010. In subjects with ICD10 data only, the PPV for the updated 2010 RA algorithm was 93%. Conclusion The 2010 RA algorithm validated with the updated data with similar performance characteristics as the 2010 data. While the 2010 algorithm continued to perform better than the rule-based approach, the PPV of the latter also remained stable over time.


2012 ◽  
Vol 33 (6) ◽  
pp. 581-588 ◽  
Author(s):  
Lisa M. Rosen ◽  
Tao Liu ◽  
Roland C. Merchant

Background.Blood and body fluid exposures are frequently evaluated in emergency departments (EDs). However, efficient and effective methods for estimating their incidence are not yet established.Objective.Evaluate the efficiency and accuracy of estimating statewide ED visits for blood or body fluid exposures using International Classification of Diseases, Ninth Revision (ICD-9), code searches.Design.Secondary analysis of a database of ED visits for blood or body fluid exposure.Setting.EDs of 11 civilian hospitals throughout Rhode Island from January 1, 1995, through June 30, 2001.Patients.Patients presenting to the ED for possible blood or body fluid exposure were included, as determined by prespecified ICD-9 codes.Methods.Positive predictive values (PPVs) were estimated to determine the ability of 10 ICD-9 codes to distinguish ED visits for blood or body fluid exposure from ED visits that were not for blood or body fluid exposure. Recursive partitioning was used to identify an optimal subset of ICD-9 codes for this purpose. Random-effects logistic regression modeling was used to examine variations in ICD-9 coding practices and styles across hospitals. Cluster analysis was used to assess whether the choice of ICD-9 codes was similar across hospitals.Results.The PPV for the original 10 ICD-9 codes was 74.4% (95% confidence interval [CI], 73.2%–75.7%), whereas the recursive partitioning analysis identified a subset of 5 ICD-9 codes with a PPV of 89.9% (95% CI, 88.9%–90.8%) and a misclassification rate of 10.1%. The ability, efficiency, and use of the ICD-9 codes to distinguish types of ED visits varied across hospitals.Conclusions.Although an accurate subset of ICD-9 codes could be identified, variations across hospitals related to hospital coding style, efficiency, and accuracy greatly affected estimates of the number of ED visits for blood or body fluid exposure.


2017 ◽  
Vol 25 (6) ◽  
pp. 287-290 ◽  
Author(s):  
GIOVANNA DAMM RAPHAEL JUNQUEIRA ◽  
ANDRÉ LUIZ MACHADO LIMA ◽  
ROBISON BONI ◽  
JOELMAR CÉSAR DE ALMEIDA ◽  
RAFAEL SOUZA RIBEIRO ◽  
...  

ABSTRACT Objectives: A retrospective statistical data gathering of wrist and hand complaints assisted over two years in the orthopedic emergency department of a regional referral hospital, seeking to know the profile of these patients. Methods: Information obtained by analysis of 31.356 orthopedic visits from May 2013 to April 2015, of which 6.754 related to hand complaints and/or wrist, at the Hospital Estadual Doutor Jayme dos Santos Neves (HDJSN) and analyzed by IBM SPSS Statistics software version 21. Results: The data revealed that the average age was 37,5 ± 15,7 years and the male gender was predominant (60,72%). Bruises (52,58%) and fractures (30,49%) were the most common diagnoses. Conclusion: The complaints of wrist and hand accounted for 21,44% of all orthopedic emergency room visits. Detailed data description and correct definition of the International Classification of Diseases (ICD-10) are needed to better define the epidemiological profile of patients seeking orthopedic emergency. Level of Evidence III, Retrospective Study.


2019 ◽  
pp. 160-163
Author(s):  
Anusha G Bhat ◽  
Kevin White ◽  
Kyle Gobeil ◽  
Tara Lagu ◽  
Peter K Lindenauer ◽  
...  

Prior studies of stress cardiomyopathy (SCM) have used International Classification of Diseases (ICD) codes to identify patients in administrative databases without evaluating the validity of these codes. Between 2010 and 2016, we identified 592 patients discharged with a first known principal or secondary ICD code for SCM in our medical system. On chart review, 580 charts had a diagnosis of SCM (positive predictive value 98%; 95% CI: 96.4-98.8), although 38 (6.4%) did not have active clinical manifestations of SCM during the hospitalization. Moreover, only 66.8% underwent cardiac catheterization and 91.5% underwent echocardiography. These findings suggest that, although all but a few hospitalized patients with an ICD code for SCM had a diagnosis of SCM, some of these were chronic cases, and numerous patients with a new diagnosis of SCM did not undergo a complete diagnostic workup. Researchers should be mindful of these limitations in future studies involving administrative databases.


2019 ◽  
Vol 13 (2) ◽  
pp. 25 ◽  
Author(s):  
Zahra Tolou-Ghamari

Background: Previous publication reported a significant disparity of genital cancer incidence between genders. The aim of this study is to investigate period prevalence (PP) and incidence (Irs) of genital cancer in Isfahan/Iran. Methods: Information equivalent to those collected by the USA Surveillance, Epidemiology, and End Results (SEER) program was obtained from the Isfahan Cancer Registry. Period prevalence (PP) was calculated per 100.000 persons. The cancer sites studied were defined according to the International Classification of Diseases (ICD-O; Third Edition) and recorded by topography code. Results: Between the years 2011 to 2015, among all registered cases (3024 cases), 60% applied to the male genital system. The mean (SD) age at diagnosis was higher for men 69.4 (14.7) than women 57.8 (15) (t-test; P<0.006). The calculated PP was significantly (Chi-squared test; P<0.001) higher in males (71.5) than females (49.6) per 100.000 in Isfahan Province. Conclusions: The PP for ovarian cancer in female and prostate cancer in male was higher than for other genital tumors. To facilitate early diagnosis for better management, we recommend that health-care plans for Isfahan Province/Iran place a greater focus on pharmacotherapy and environmental factors in cancer control.


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