scholarly journals Risk Factors and Complications Following Arthroscopic Tenotomy of the Long Head of the Biceps Tendon

2020 ◽  
Vol 8 (2) ◽  
pp. 232596712090436 ◽  
Author(s):  
Raffy Mirzayan ◽  
Christopher McCrum ◽  
Rebecca K. Butler ◽  
Ram Kiran Alluri
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Smoking Status ◽  
Biceps Tendon ◽  
Workers Compensation ◽  
Level Of Evidence ◽  
Related Factors ◽  
Compensation Claims ◽  
Long Head ◽  
Popeye Deformity

Background: Controversy exits regarding performing a tenotomy versus a tenodesis of the long head of the biceps tendon (LHBT). Purpose: To evaluate the complications after arthroscopic tenotomy of the LHBT and characterize the incidence of cosmetic deformity, cramping, subjective weakness, and continued anterior shoulder pain (ASP). Additionally, to identify patient-related factors that may predispose a patient to these complications. Study Design: Case-control study; Level of evidence, 3. Methods: Records of patients who underwent an arthroscopic LHBT tenotomy at an integrated health care system under the care of 55 surgeons were retrospectively reviewed. Exclusion criteria included LHBT tenodesis, arthroplasty, neoplastic, or fracture surgery; age younger than 18 years; incomplete documentation of physical examination; or incomplete operative reports. Characteristic data, concomitant procedures, LHBT morphology, and postoperative complications were recorded. Patients with and without postoperative complications—including cosmetic deformity, subjective weakness, continued ASP, and cramping—were analyzed by age, sex, dominant arm, body mass index (BMI), smoking status, workers’ compensation status, and intraoperative LHBT morphology to identify risk factors for developing these postoperative complications. Results: A total of 192 patients who underwent LHBT tenotomy were included in the final analysis. Tenotomy was performed with concomitant shoulder procedures in all but 1 individual. The mean ± SD patient age was 60.6 ± 9.5 years, and 55% were male. The overall complication rate was 37%. The most common postoperative complications include cosmetic (Popeye) deformity (14.1%), subjective weakness (10.4%), cramping (10.4%), and continued postoperative ASP over the bicipital groove (7.8%). Every 10-year increase in age was associated with 0.52 (95% CI, 0.28-0.94) times the odds of continued ASP and 0.59 (95% CI, 0.36-0.98) times the odds of cramping pain. Male patients had 3.9 (95% CI, 1.4-10.8) times the odds of cosmetic (Popeye) deformity. Patients who had active workers’ compensation claims had 12.5 (95% CI, 2.4-63.4) times the odds of having continued postoperative ASP. Tenotomy on the dominant arm, BMI, and active smoking status demonstrated no statistically significant association with postoperative complications. Conclusion: Patients experiencing complications after tenotomy were significantly younger and more likely to be male and to have a workers’ compensation injury. LHBT tenotomy may best be indicated for elderly patients, female patients, and those without active workers’ compensation claims.

scholarly journals Risk Factors for Biceps Related Complications Following Arthroscopic Tenotomy of the Long Head of the Biceps Tendon

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0016
Author(s):  
Raffy Mirzayan ◽  
Christopher L. McCrum ◽  
Rebecca K. Butler ◽  
Ram Kirin Alluri
Keyword(s):  
Postoperative Complications ◽  
Shoulder Pain ◽  
Odds Ratio ◽  
Biceps Tendon ◽  
Male Gender ◽  
Workers Compensation ◽  
Related Factors ◽  
Compensation Status ◽  
Long Head ◽  
Anterior Shoulder Pain

Objectives: Our objective was to evaluate complications after arthroscopic tenotomy of the long head of the biceps tendon (LHBT) and identify patient-related factors associated with postoperative cosmetic (Popeye) deformity, subjective weakness, and residual anterior shoulder pain. Methods: After obtaining IRB approval, the records of patients who underwent an arthroscopic LHBT tenotomy, between 2008 and 2015, at an integrated multi-center (14) and multi-surgeon (55) were retrospectively reviewed. Exclusion criteria included LHBT tenodesis, arthroplasty, neoplastic, or fracture surgery, age below 18, or indata. Demographic data, concomitant procedures, the appearance of the biceps tendon (presence or absence of hypertrophy) at time of arthroscopy, and postoperative complications were recorded. The development of each postoperative complication was compared by age, gender, hand dominance, workers’ compensation status, and intra-operative LHBT morphology. Results: 192 patients met our inclusion criteria. The average age was 60.6 ± 9.5 years and 55% were male. Average follow-up was 10.6 ± 13.6 months. The most common concomitant procedures were subacromial decompression (82%), rotator cuff repair (72%), distal clavicle resection (26%), and glenohumeral debridement (18%). LHBT morphology based on arthroscopic images was as follows: normal (56%), mildly hypertrophic (24%), severely hypertrophic (20%). Postoperative complications cosmetic deformity (14%), subjective weakness (10.4%), persistent (residual) anterior shoulder pain (7.8%), conversion to tenodesis (3.6%), venous thromboembolism (1%). Seven (3.6%) patients underwent a revision surgery to convert the LHBT tenotomy to a tenodesis, most commonly for postoperative cosmetic deformity (6 patients, 86%). Male gender was significantly associated with the development of postoperative cosmetic deformity (Odds Ratio of 3.21, P<0.05). Biceps tenotomy on the dominant shoulder was significantly associated with postoperative subjective weakness (Odds Ratio 3.17, P<0.05). Patients with workers’ compensation injuries were more likely to have continued postoperative anterior shoulder pain (6.57, P<0.05). A full list of individual patient-related factors association with postoperative complications is presented in Table 1. Conclusion: In our series, in patients undergoing LHBT tenotomy, 14% developed a cosmetic deformity, 10% subjective reported weakness and 8% had persistent (residual) anterior shoulder pain. Male gender was associated with developing a cosmetic deformity, the dominant shoulder was associated with postoperative subjective weakness, and workers’ compensation status was associated with residual anterior shoulder pain. Older age and a hypertrophic biceps tendon demonstrated decreased odds of developing a postoperative cosmetic deformity but did not reach statistical significance. Surgeons who perform LHBT tenotomy should take these risk factors under consideration to minimize complications. [Table: see text]

scholarly journals Rates and Risk Factors for Revision Open and Arthroscopic Proximal Biceps Tenodesis

2019 ◽  
Vol 7 (2) ◽  
pp. 232596711882547 ◽  
Author(s):  
Brian Forsythe ◽  
Avinesh Agarwalla ◽  
Richard N. Puzzitiello ◽  
Randy Mascarenhas ◽  
Brian C. Werner
Keyword(s):  
Risk Factors ◽  
Rotator Cuff ◽  
Protective Factors ◽  
Biceps Tendon ◽  
Rotator Cuff Tears ◽  
Biceps Tenodesis ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Male Sex ◽  
Long Head

Background: Biceps tenodesis may be performed for symptomatic tendinopathy or tearing of the long head of the biceps tendon. Biceps tenodesis is also commonly performed as an adjunctive procedure. However, the indications and prevalence of biceps tenodesis have expanded. Purpose: To establish the incidence and risk factors for revision biceps tenodesis. Study Design: Case-control study; Level of evidence, 2. Methods: The PearlDiver database of Humana patient data was queried for patients undergoing arthroscopic or open biceps tenodesis (Current Procedural Terminology [CPT] 29828 and CPT 23430, respectively) from 2008 through the first quarter of 2017. Patients without a CPT laterality modifier were excluded from analysis. Revision biceps tenodesis was defined as patients who underwent subsequent ipsilateral open or arthroscopic biceps tenodesis. The financial impact of revision biceps tenodesis was also calculated. Multivariate binomial logistic regression was performed to identify risk factors for revision biceps tenodesis, such as patient demographics as well as concomitant procedures and diagnoses. Odds ratios (ORs) and 95% CIs were calculated, and all statistical comparisons with P < .05 were considered significant. Results: There were 15,257 patients who underwent biceps tenodesis. Of these, 9274 patients (60.8%) underwent arthroscopic biceps tenodesis, while 5983 (39.2%) underwent open biceps tenodesis. A total of 171 patients (1.8%) and 111 patients (1.9%) required revision biceps tenodesis after arthroscopic and open biceps tenodesis, respectively ( P = .5). Male sex (OR, 1.38 [95% CI, 1.04-1.85]; P = .02) was the only independent risk factor for revision biceps tenodesis after the index open biceps tenodesis. After arthroscopic biceps tenodesis, age >45 years (OR, 0.58 [95% CI, 0.39-0.89]; P = .01) and concomitant rotator cuff tear (OR, 0.58 [95% CI, 0.47-0.71]; P < .001) were independent protective factors for revision biceps tenodesis. The total cost of revision biceps tenodesis after open and arthroscopic biceps tenodesis was US$3427.95 and US$2174.33 per patient, respectively. Conclusion: There was no significant difference in the revision rate between arthroscopic and open biceps tenodesis. Risk factors for revision surgery included male sex for open biceps tenodesis, while age >45 years and rotator cuff tears were protective factors for arthroscopic biceps tenodesis.

scholarly journals Impact of Intraoperative Gravity-Dependent Atelectasis Following Laparoscopic Liver Resection Performed in the Lateral Position

2021 ◽  
Author(s):  
Ryoichi Miyamoto ◽  
Toshiro Ogura ◽  
Amane Takahashi ◽  
Akifumi Kimura ◽  
Shinichi Matsudaira ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Resection ◽  
Postoperative Complications ◽  
Laparoscopic Liver Resection ◽  
Operating Time ◽  
Multivariate Logistic Regression Analysis ◽  
Lateral Position ◽  
Cancer Center ◽  
Related Factors ◽  
Left Half

Abstract Purpose Laparoscopic liver resection (LLR) is currently an accepted approach for liver surgery in select patients. The correlation between the intraoperative position and the presence of gravity-dependent atelectasis (GDA) has been well discussed. However, LLR is performed in the left half lateral position, and the relationship between this position and the presence of GDA remains unclear. We evaluated the extent to which the intraoperative left half lateral position affects the presence of GDA. Furthermore, univariate and multivariate analyses were performed to identify potential risk factors for LLR postoperative complications with a special emphasis on the presence of GDA by comparing various patient-, liver- and surgery-related factors in a retrospective cohort. Methods We retrospectively evaluated 129 patients who underwent LLR in the left half lateral position at the Saitama Cancer Center in Saitama, Japan between March 2011 and July 2020. The frequency and duration of GDA were investigated. We divided the cohort into with GDA and without GDA groups based on a cutoff value (≥ 5 days, n = 61 and < 5 days, n = 68, respectively). Using multivariate analysis, the duration of GDA and several risk factors for LLR postoperative complications were independently assessed. Results Postoperative GDA was observed in 61 patients (47%) and lasted for 1 to 8 days in these patients. The mean duration of GDA was 4.3 days. Multivariate logistic regression analysis revealed a GDA duration of 5 days or more (odds ratio [OR], 2.03; p = 0.001) and an operating time > 388 minutes (OR, 5.31; p < 0.001) to be independent risk factors for LLR postoperative complications. Conclusions The incidence and duration of postoperative GDA are considered useful predictors of postoperative complications, and these predictors should be assessed to improve the short-term outcomes of patients undergoing LLR.

Patient-Related Factors and Complications After Arthroscopic Tenotomy of the Long Head of the Biceps Tendon

2011 ◽  
Vol 39 (4) ◽  
pp. 783-789 ◽  
Author(s):  
Tae Kang Lim ◽  
Eun Sun Moon ◽  
Kyoung Hwan Koh ◽  
Jae Chul Yoo
Keyword(s):  
Biceps Tendon ◽  
Related Factors ◽  
Long Head

scholarly journals Preoperative Nutritional Status and Risk Factors Associated with Delayed Discharge in Geriatric Patients Undergoing Gastrectomy: A Single-Center Retrospective Study

2021 ◽  
Author(s):  
Xining Zhao ◽  
Jie Liu ◽  
Ying Wang ◽  
Yuying Yang ◽  
Yan Pan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Postoperative Complications ◽  
Geriatric Patients ◽  
Cox Regression ◽  
Significant Risk ◽  
Related Factors ◽  
Factors Associated ◽  
Delayed Discharge ◽  
Significant Difference

Abstract Background Preoperative malnutrition is an independent risk factor for postoperative complications and survival for gastric cancer (GC) patients. This study aimed to investigate the prevalence of malnutrition and the risk factors associated with the delayed discharge of geriatric patients undergoing gastrectomy. Material and Methods A retrospective study of GC patients (age ≥ 65) who underwent gastrectomy at Zhongshan Hospital from January 2018 to May 2020 was conducted. Clinical data, including demographic information, medical history, surgery-related factors, and perioperative nutritional management were collected and analyzed. Results A total of 783 patients were reviewed. The overall frequency of malnutrition was 31.3% (249/783). The levels of albumin, prealbumin, and hemoglobin were lower in the malnutrition group compared with the well-nourished group. Moreover, 51 (6.5%) patients received preoperative total parenteral nutritional support. All patients received postoperative parenteral nutrition; 194 (77.9%) patients in the malnutrition group received an infusion of carbohydrates with composite amino acid and 55 (22.1%) received total nutrient admixture. No significant difference was found in the duration of postoperative nutrition between the groups (P>0.05). The malnutrition group was associated with a higher rate of surgical site infections (SSIs) (P<0.001). Multivariate cox regression revealed that age >70 years, length of surgery >180 min, and postoperative complications were significant risk factors associated with delayed discharge. Conclusion Malnutrition is relatively common in elderly patients undergoing gastrectomy. Age, length of surgery, and postoperative complications are important risk factors associated with delayed discharge. Elderly GC patients with risk factors urgently require specific attention to shorten hospital stays.

scholarly journals Subsequent Pain or Injury After Foot and Ankle Surgery in Patients Receiving Workers’ Compensation

2019 ◽  
Vol 41 (1) ◽  
pp. 17-24
Author(s):  
Gabrielle Bui ◽  
Yubo Gao ◽  
Natalie Glass ◽  
Christopher Cychosz ◽  
John Lawrence Marsh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Retrospective Chart Review ◽  
Anatomical Location ◽  
Workers Compensation ◽  
Foot And Ankle ◽  
Chi Square ◽  
Level Of Evidence ◽  
Legal Representation ◽  
Ankle Surgery

Background: Workers’ compensation (WC) has been associated with poor outcomes following a variety of injuries and surgeries, but rates of subsequent pain or injury (SPI) following surgery have not been studied. The purpose of this study was to investigate the rates, locations, and risk factors of SPI in WC patients and non-WC patients who underwent the same surgeries. Methods: With institutional review board approval, records from foot or ankle surgery performed by author P.P. from 2009 to 2015 were obtained. A retrospective chart review was performed on all WC and non-WC patients with at least 1 Current Procedural Terminology code of interest. SPI was defined as a new injury at a different anatomical location occurring 2 months to 2 years after the index surgery. Chi-square and 2-tailed t tests were used to compare risk factors and rates of SPI in both groups. Results: The WC population had higher rates of SPI than the non-WC population. Specifically, 13 of 56 WC patients (23.2%) vs 12 of 165 non-WC patients (7.3%) reported SPI ( P = .001). The hip, knee, and contralateral foot and ankle were common areas of SPI in both groups. Legal representation and increased age were risk factors for SPI in the WC population. Specifically, 10 of 13 WC patients with SPI had legal representation vs 16 of 43 WC patients without SPI ( P = .02). Female sex was a risk factor for SPI in the non-WC population. Conclusions: WC patients had higher rates of subsequent pain or injury than non-WC patients. Legal representation was a risk factor for SPI in the WC population. Level of Evidence: Level III, comparative series.

scholarly journals Predisposing factors to acquisition of acute respiratory tract infections in the community: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ashley Hammond ◽  
Alice Halliday ◽  
Hannah V. Thornton ◽  
Alastair D. Hay
Keyword(s):  
Risk Factors ◽  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Smoking Status ◽  
Predisposing Factors ◽  
Vulnerable Groups ◽  
Antibiotic Prescribing ◽  
Related Factors ◽  
Factors Associated ◽  
Tract Infections

Abstract Background Preventing respiratory tract infections (RTIs) could have profound effects on quality of life, primary care workload, antibiotic prescribing and stewardship. We aimed to identify factors that increase and decrease RTI acquisition within Organisation for Economic Cooperation and Development (OECD) member countries. Methods Systematic search of Medline, Embase, Cochrane and ISI Web of Knowledge for studies conducted up to July 2020 reporting predisposing factors for community RTI acquisition. Pooled odds ratios were calculated using a random-effects model. Results 23 studies investigated risk factors associated with community-acquired pneumonia (n = 15); any RTI (n = 4); influenza like illness (n = 2); and lower RTI (n = 2). Demographic, lifestyle and social factors were: underweight BMI (pooled odds ratio (ORp 2.14, 95% CI 1.58 to 2.70, p = 0.97); male sex (ORp 1.30, 95% CI 1.27 to 1.33, p = 0.66); contact with pets (ORp 1.35, 95% CI 1.16 to 1.54, p = 0.72); contact with children (ORp 1.35, 95% CI 1.15 to 1.56, p = 0.05); and ex-smoking status (ORp 1.57, 95% CI 1.26 to 1.88, p = 0.76). Health-related factors were: chronic liver condition (ORp 1.30, 95% CI 1.09 to 1.50, p = 0.34); chronic renal condition (ORp 1.47, 95% CI 1.09 to 1.85, p = 0.14); and any hospitalisation in previous five years (ORp 1.64, 95% CI 1.46 to 1.82, p = 0.66). Conclusions We identified several modifiable risk factors associated with increased likelihood of acquiring RTIs in the community, including low BMI, contact with children and pets. Modification of risk factors and increased awareness of vulnerable groups could reduce morbidity, mortality and antibiotic use associated with RTIs. PROSPERO registration CRD42019134176.

Differences in risk factors exist for the occurrence of bilateral versus unilateral distal biceps tendon ruptures: a systematic review

2020 ◽  
pp. jisakos-2020-000570
Author(s):  
Christina Barrett Hawkins ◽  
Rebecca Abromitis ◽  
Carola van Eck
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Biceps Tendon ◽  
Meta Analysis ◽  
Distal Biceps Tendon ◽  
Level Of Evidence ◽  
Distal Biceps ◽  
Biceps Rupture ◽  
Tendon Ruptures ◽  
Distal Biceps Rupture

ImportanceDistal biceps rupture is a debilitating injury that is increasing in incidence. A subset of patient experiences this injury on both sides, simultaneously or at separated times. Previous studies have evaluated the incidence and risk factors of unilateral distal biceps rupture. However, little is known about the risk factors for bilateral distal biceps rupture.AimsThis aims of this study were to determine risk factors for bilateral distal biceps rupture and to compare these to the known risk factors for unilateral rupture.Evidence reviewA systematic review of literature was conducted using five databases, producing a total of 1183 papers. After the review process, 31 papers with data bilateral distal biceps tendon ruptures were included.FindingsThe 31 papers included a total of 2234 patients with 2366 ruptures. Patients with a bilateral rupture were younger than patients with unilateral ruptures (45.8 vs 48.8 years old). Women made up a larger percentage of patients with bilateral ruptures (6.8% vs 4.0%). Bilateral injuries occurred most commonly during heavy lifting or falls, whereas forced extension of the arm was the most frequently reported injury mechanism reported with unilateral ruptures. Tobacco used was more common in patients with bilateral ruptures (24.4% vs 6.8%). Labour-intensive occupations and anabolic steroid use did not appear to increase the risk of a bilateral rupture. Pooling of the data was not possible due to heterogeneity of the included studies.ConclusionsWhile differences in risk factors between patients with unilateral and bilateral ruptures were observed, there was too great of a degree of heterogeneity among the studies to perform a meta-analysis of the data.Level of evidenceSystematic review; level III evidence.

scholarly journals Relationship between long head of the biceps tendon histopathology and long-term functional results in smokers. A time to reevaluate the Bonar score?

2021 ◽  
Vol 12 ◽  
pp. 204062232199026
Author(s):  
Jan Zabrzyński ◽  
Maciej Gagat ◽  
Łukasz Łapaj ◽  
Łukasz Paczesny ◽  
Alper Yataganbaba ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Shoulder Arthroscopy ◽  
Smoking Status ◽  
Biceps Tendon ◽  
Functional Results ◽  
Morphological Alterations ◽  
Histopathologic Evaluation ◽  
Long Head

Aim: The purpose of this study was to investigate whether there is an association between smoking, the extent of the degeneration process in the biceps tendinopathy, including cells and extracellular matrix (ECM) alterations, and long-term surgical results. Methods: This study comprised 40 consecutive patients admitted for shoulder arthroscopy due to symptomatic biceps tendinopathy and classified into three groups based on smoking status: active smokers, former smokers, and non-smokers. According to the classical Bonar score criteria, the histopathologic evaluation of the harvested intra-articular portion of the tendon was done. The follow-up examination was based on the American Shoulder and Elbow Surgeons Score (ASES). Results: A cohort of 32 patients was enrolled in the final follow-up examination; mean 37.56 months. Histopathological evaluation according to the classical Bonar score revealed degeneration of the tendinous tissue in each group but there was no correlation between the extent of degeneration, smoking indexes and the ASES. After revision of Bonar scale within the vascularity criterion, we found a correlation between the extent of degeneration of tendinous tissue, smoking data, ASES score, and the severity of rotator cuff injury. Conclusion: In this paper, we indicate the ambiguous role of the neovascularization in the biceps tendinopathy, and it was used for modification of the classical Bonar score. Consequently, recalculated, modified Bonar score was correlated positively with smoking indexes and functional outcomes. Furthermore, the morphological alterations of rotator cuff tendons also correlated positively with the extent of biceps tendon degeneration, measured according to the modified scoring system.

Sign in / Sign up

Export Citation Format

Share Document