Non-union Rates in Hind and Midfoot Arthrodesis in Current, Ex-, and Non-smokers

Category: Hindfoot Introduction/Purpose: Arthrodesis is a safe and effective treatment for a number of hind and midfoot conditions. However, non-union rates have historically been reported as high as 41%. A number of factors have been identified that increase non-union rates, the most notable and readily modifiable is a patient’s smoking status. Smoking rates in the UK in 2015 were 19.3% for men and 15.3% for women. We have examined the effect of smoking status (current, ex-smokers and non-smokers) on union rates for a large cohort of patients undergoing hind or midfoot arthrodesis. Methods: This is a single surgeon, retrospective cohort study of consecutive cases. The surgeon’s logbook was used to identify patients undergoing any hind and midfoot arthrodesis procedures from January 2010 until September 2016. Revision procedures and charcot arthropathy cases were excluded along with cases with insufficient records available. Demographic data was collected along with: joints involved, surgical implant used, bone grafting, the use of ultrasound bone stimulation (EXOGEN, Bioventus LLC, Durham, USA) therapy, complications and final outcome with regards to union. Patients were divided according to self-reported smoking status at pre-operative assessment; current smokers, ex-smokers and non-smokers. Union outcome was based on clinical notes and included patient symptoms and radiographic evidence. Delayed union was classed as union occurring after 6 months. The effect of smoking status on deep infection rates and the need for EXOGEN therapy was also analysed. Results: 381 joints were included (see image). The smoking prevalence was 14.0% (accounting for 12.3% of joints) and 32.2% ex-smokers (35.4%). The groups were comparable with regards to gender, diabetes status and BMI. Smokers were younger, had less co-morbidities and were less likely to have had multiple joints fused (p<0.05). Non-union rates were statistically higher in current smokers with a relative risk of 5.81 (95% CI 2.54-13.29, P<0.001), there was no statistically significant difference between ex-smokers and non-smokers. Active smokers had higher rates of deep infection (P=0.05) and the need for EXOGEN use (P<0.001). Within the smoking group there was a trend toward slower union (delayed + non-union) with heavier smoking (p=0.054). Conclusion: This large retrospective cohort study confirms previous evidence that smoking has a considerable negative effect on union in arthrodesis (despite other differences between the groups likely to favour union in smokers). A 5.8 relative risk in a modifiable risk factor is extremely high. Arthrodesis surgery should be undertaken with extreme caution in patients who are actively smoking. Our study shows that after cessation of smoking the risk returns to normal, however we have not quantified the time frame. Further research is needed to quantify the necessary time frame for smoking cessation to reduce non-union risk.

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Nonunion Rates in Hind- and Midfoot Arthrodesis in Current, Ex-, and Nonsmokers

Foot & Ankle International ◽

10.1177/1071100720971269 ◽

2020 ◽

pp. 107110072097126

Author(s):

Jack Allport ◽

Jayasree Ramaskandhan ◽

Malik S. Siddique

Keyword(s):

Risk Factor ◽

Cohort Study ◽

Relative Risk ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Smoking Status ◽

Time Frame ◽

Modifiable Risk Factor ◽

Level Of Evidence ◽

Significant Difference

Background: Nonunion rates in hind or midfoot arthrodesis have been reported as high as 41%. The most notable and readily modifiable risk factor that has been identified is smoking. In 2018, 14.4% of the UK population were active smokers. We examined the effect of smoking status on union rates for a large cohort of patients undergoing hind- or midfoot arthrodesis. Methods: In total, 381 consecutive primary joint arthrodeses were identified from a single surgeon’s logbook (analysis performed on a per joint basis, with a triple fusion reported as 3 separate joints). Patients were divided based on self-reported smoking status. Primary outcome was clinical union. Delayed union, infection, and the need for ultrasound bone stimulation were secondary outcomes. Results: Smoking prevalence was 14.0%, and 32.2% were ex-smokers. Groups were comparable for sex, diabetes, and body mass index. Smokers were younger and had fewer comorbidities. Nonunion rates were higher in smokers (relative risk, 5.81; 95% CI, 2.54-13.29; P < .001) with no statistically significant difference between ex-smokers and nonsmokers. Smokers had higher rates of infection ( P = .05) and bone stimulator use ( P < .001). Among smokers, there was a trend toward slower union with heavier smoking ( P = .004). Conclusion: This large retrospective cohort study confirmed previous evidence that smoking has a considerable negative effect on union in arthrodesis. The 5.81 relative risk in a modifiable risk factor is extremely high. Arthrodesis surgery should be undertaken with extreme caution in smokers. Our study shows that after cessation of smoking, the risk returns to normal, but we were unable to quantify the time frame. Level of Evidence: Level III, retrospective cohort study.

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387. Markers for Mortality in COVID-19 Patients with Atrial Fibrillation or Flutter

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.582 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S262-S262

Author(s):

Kok Hoe Chan ◽

Bhavik Patel ◽

Iyad Farouji ◽

Addi Suleiman ◽

Jihad Slim

Keyword(s):

Atrial Fibrillation ◽

Logistic Regression ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Prognostic Markers ◽

Univariate Analysis ◽

Laboratory Data ◽

Significant Difference ◽

New Onset

Abstract Background Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection can lead to many different cardiovascular complications, we were interested in studying prognostic markers in patients with atrial fibrillation/flutter (A. Fib/Flutter). Methods A retrospective cohort study of patients with confirmed COVID-19 and either with existing or new onset A. Fib/Flutter who were admitted to our hospital between March 15 and May 20, 2020. Demographic, outcome and laboratory data were extracted from the electronic medical record and compared between survivors and non-survivors. Univariate and multivariate logistic regression were employed to identify the prognostic markers associated with mortality in patients with A. Fib/Flutter Results The total number of confirmed COVID-19 patients during the study period was 350; 37 of them had existing or new onset A. Fib/Flutter. Twenty one (57%) expired, and 16 (43%) were discharged alive. The median age was 72 years old, ranged from 19 to 100 years old. Comorbidities were present in 33 (89%) patients, with hypertension (82%) being the most common, followed by diabetes (46%) and coronary artery disease (30%). New onset of atrial fibrillation was identified in 23 patients (70%), of whom 13 (57%) expired; 29 patients (78%) presented with atrial fibrillation with rapid ventricular response, and 2 patients (5%) with atrial flutter. Mechanical ventilation was required for 8 patients, of whom 6 expired. In univariate analysis, we found a significant difference in baseline ferritin (p=0.04), LDH (p=0.02), neutrophil-lymphocyte ratio (NLR) (p=0.05), neutrophil-monocyte ratio (NMR) (p=0.03) and platelet (p=0.015) between survivors and non-survivors. With multivariable logistic regression analysis, the only value that had an odds of survival was a low NLR (odds ratio 0.74; 95% confidence interval 0.53–0.93). Conclusion This retrospective cohort study of hospitalized patients with COVID-19 demonstrated an association of increase NLR as risk factors for death in COVID-19 patients with A. Fib/Flutter. A high NLR has been associated with increased incidence, severity and risk for stroke in atrial fibrillation patients but to our knowledge, we are first to demonstrate the utilization in mortality predictions in COVID-19 patients with A. Fib/Flutter. Disclosures Jihad Slim, MD, Abbvie (Speaker’s Bureau)Gilead (Speaker’s Bureau)Jansen (Speaker’s Bureau)Merck (Speaker’s Bureau)ViiV (Speaker’s Bureau)

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The change of coagulation profile in two-staged arthroplasty for periprosthetic joint infection patients: a retrospective cohort study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02477-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Hao Li ◽

Rui Li ◽

L. L. Li ◽

Wei Chai ◽

Chi Xu ◽

...

Keyword(s):

Cohort Study ◽

Periprosthetic Joint Infection ◽

Retrospective Cohort Study ◽

Persistent Infection ◽

Retrospective Cohort ◽

Joint Infection ◽

Diagnostic Study ◽

Level Of Evidence ◽

Coagulation Profile ◽

Significant Difference

Abstract Aims Periprosthetic joint infection (PJI) is a serious complication of total joint arthroplasty. We performed a retrospective cohort study to evaluate (1) the change of coagulation profile in two-staged arthroplasty patients and (2) the relationship between coagulation profile and the outcomes of reimplantation. Method Between January 2011 and December 2018, a total of 202 PJI patients who were operated on with two-staged arthroplasty were included in this study initially. This study continued for 2 years and the corresponding medical records were scrutinized to establish the diagnosis of PJI based on the 2014 MSIS criteria. The coagulation profile was recorded at two designed points, (1) preresection and (2) preimplantation. The difference of coagulation profile between preresection and preimplantation was evaluated. Receiver operating characteristic curves (ROC) were used to evaluate the diagnostic efficiency of the coagulation profile and change of coagulation profile for predicting persistent infection before reimplantation. Results The levels of APTT, INR, platelet count, PT, TT, and plasma fibrinogen before spacer implantation were significantly higher than before reimplantation. No significant difference was detected in the levels of D-dimer, ACT, and AT3 between the two groups. The AUC of the combined coagulation profile and the change of combined coagulation profile for predicting persistent infection before reimplantation was 0.667 (95% CI 0.511, 0.823) and 0.667 (95% CI 0.526, 0.808), respectively. Conclusion The coagulation profile before preresection is different from before preimplantation in two-staged arthroplasty and the coagulation markers may play a role in predicting infection eradication before reimplantation when two-stage arthroplasty is performed. Level of evidence Level III, diagnostic study.

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Community-acquired bacteraemia in COVID-19 in comparison to influenza A and influenza B: a retrospective cohort study

BMC Infectious Diseases ◽

10.1186/s12879-021-05902-5 ◽

2021 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Julinha M. Thelen ◽

A. G. ( Noud) Buenen ◽

Marjan van Apeldoorn ◽

Heiman F. Wertheim ◽

Mirjam H. A. Hermans ◽

...

Keyword(s):

Cohort Study ◽

Blood Culture ◽

The Netherlands ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Influenza A ◽

Blood Cultures ◽

Influenza B ◽

Significant Difference ◽

All Cause Mortality

Abstract Background During the coronavirus disease 2019 (COVID-19) pandemic in the Netherlands it was noticed that very few blood cultures from COVID-19 patients turned positive with clinically relevant bacteria. This was particularly evident in comparison to the number of positive blood cultures during previous seasonal epidemics of influenza. This observation raised questions about the occurrence and causative microorganisms of bacteraemia in COVID-19 patients, especially in the perspective of the widely reported overuse of antibiotics and the rising rate of antibiotic resistance. Methods We conducted a retrospective cohort study on blood culture results in influenza A, influenza B and COVID-19 patients presenting to two hospitals in the Netherlands. Our main outcome consisted of the percentage of positive blood cultures. The percentage of clinically relevant blood cultures, isolated bacteria and 30-day all-cause mortality served as our secondary outcomes. Results A total of 1331 viral episodes were analysed in 1324 patients. There was no statistically significant difference (p = 0.47) in overall occurrence of blood culture positivity in COVID-19 patients (9.0, 95% CI 6.8–11.1) in comparison to influenza A (11.4, 95% CI 7.9–14.8) and influenza B patients (10.4, 95% CI 7.1–13.7,). After correcting for the high rate of contamination, the occurrence of clinically relevant bacteraemia in COVID-19 patients amounted to 1.0% (95% CI 0.3–1.8), which was statistically significantly lower (p = 0.04) compared to influenza A patients (4.0, 95% CI 1.9–6.1) and influenza B patients (3.0, 95% CI 1.2–4.9). The most frequently identified bacterial isolates in COVID-19 patients were Escherichia coli (n = 2) and Streptococcus pneumoniae (n = 2). The overall 30-day all-cause mortality for COVID-19 patients was 28.3% (95% CI 24.9–31.7), which was statistically significantly higher (p = <.001) when compared to patients with influenza A (7.1, 95% CI 4.3–9.9) and patients with influenza B (6.4, 95% CI 3.8–9.1). Conclusions We report a very low occurrence of community-acquired bacteraemia amongst COVID-19 patients in comparison to influenza patients. These results reinforce current clinical guidelines on antibiotic management in COVID-19, which only advise utilization of antibiotics when a bacterial co-infection is suspected.

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The Change of Coagulation Profile in Two-staged Arthroplasty for Periprosthetic Joint Infection Patients：A Retrospective Cohort Study

10.21203/rs.3.rs-157725/v1 ◽

2021 ◽

Author(s):

Hao Li ◽

Rui Li ◽

Liangliang Li ◽

Chi Xu ◽

Wei Chai ◽

...

Keyword(s):

Cohort Study ◽

Periprosthetic Joint Infection ◽

Retrospective Cohort Study ◽

Persistent Infection ◽

Retrospective Cohort ◽

Joint Infection ◽

Diagnostic Study ◽

Level Of Evidence ◽

Coagulation Profile ◽

Significant Difference

Abstract Aims：Periprosthetic joint infection (PJI) a serious complication of total joint arthroplasty. We performed a retrospective cohort study to evaluate 1) the change of coagulation profile in two-staged arthroplasty patients 2) the relationship between coagulation profile and the outcomes of reimplantation. Method: Between 2011 January and 2018 December, a total of 202 PJI patients who were performed with two-staged arthroplasty were included in this study initially. They were followed up at least 2 years and corresponding medical records were scrutinized to establish the diagnosis of PJI based on the 2014 MSIS criteria. The coagulation profile was recorded at two designed points 1) preresection and 2) preimplantation. Then, the difference of coagulation profile between preresection and preimplantation was evaluated. Besides, receiver operating characteristic curves (ROC) were used to evaluate the diagnostic efficiency of coagulation profile and the change of coagulation profile for predicting persistent infection before reimplantation. Results: The levels of APTT, INR, platelet count, PT, TT and plasma fibrinogen before spacer implantation were significantly higher than that before reimplantation. No significant difference was detected in the levels of D-dimer, ACT, AT3 between the two groups. The AUC of the combined coagulation profile and the change of combined coagulation profile for predicting persistent infection before reimplantation was 0.667 (95%CI:(0.511,0.823) and 0.667 (95%CI: (0.526,0.808)), respectively.Conclusion: The coagulation profile before preresection is different from that before preimplantation in two-staged arthroplasty and the coagulation markers may play a role in predicting infection eradication before reimplantation when two-stage arthroplasty is performed. Level of Evidence: level III, diagnostic study

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First norovirus outbreaks associated with consumption of green seaweed (Enteromorpha spp.) in South Korea

Epidemiology and Infection ◽

10.1017/s0950268814001332 ◽

2014 ◽

Vol 143 (3) ◽

pp. 515-521 ◽

Cited By ~ 14

Author(s):

J. H. PARK ◽

H. S. JEONG ◽

J. S. LEE ◽

S. W. LEE ◽

Y. H. CHOI ◽

...

Keyword(s):

Cohort Study ◽

Relative Risk ◽

Confidence Interval ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Case Control Study ◽

Case Control ◽

Green Seaweed ◽

Norovirus Gii ◽

Control Study

SUMMARYIn February 2012, an outbreak of gastroenteritis was reported in school A; a successive outbreak was reported at school B. A retrospective cohort study conducted in school A showed that seasoned green seaweed with radishes (relative risk 7·9, 95% confidence interval 1·1–56·2) was significantly associated with illness. Similarly, a case-control study of students at school B showed that cases were 5·1 (95% confidence interval 1·1–24·8) times more likely to have eaten seasoned green seaweed with pears. Multiple norovirus genotypes were detected in samples from students in schools A and B. Norovirus GII.6 isolated from schools A and B were phylogenetically indistinguishable. Green seaweed was supplied by company X, and norovirus GII.4 was isolated from samples of green seaweed. Green seaweed was assumed to be linked to these outbreaks. To our knowledge, this is the first reported norovirus outbreak associated with green seaweed.

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Effectiveness of the Bactiseal Universal Shunt for reducing shunt infection in a sub-Saharan African context: a retrospective cohort study in 160 Ugandan children

Journal of Neurosurgery Pediatrics ◽

10.3171/2013.11.peds13394 ◽

2014 ◽

Vol 13 (2) ◽

pp. 140-144 ◽

Cited By ~ 19

Author(s):

Jordan D. Lane ◽

John Mugamba ◽

Peter Ssenyonga ◽

Benjamin C. Warf

Keyword(s):

Cohort Study ◽

Low Income ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Shunt Infection ◽

Low Income Countries ◽

Rank Test ◽

Log Rank Test ◽

Significant Difference ◽

Chi Square Analysis

Object Antibiotic-impregnated shunts have yet to find widespread use in the developing world, largely due to cost. Given potential differences in the microbial spectrum, their effectiveness in preventing shunt infection for populations in low-income countries may differ and has not been demonstrated. This study is the first to compare the efficacy of a Bactiseal shunt system with a non–antibiotic-impregnated system in a developing country. Methods The Bactiseal Universal Shunt (BUS) was placed in 80 consecutive Ugandan children who required a shunt. In this retrospective cohort study, the outcome for that group was compared with the outcome for the immediately preceding 80 consecutive children in whom a Chhabra shunt had been placed. The primary end points were shunt failure, shunt infection, and death. Shunt survival was analyzed using the Kaplan-Meier method. Significance of differences between groups was tested using the log-rank test, chi-square analysis, Fisher's exact test, and t-test. Results There was no difference between groups in regard to age, sex, or etiology of hydrocephalus. Mean follow-up for cases of nonfailure was 7.6 months (median 7.8 months, interquartile range 6.5–9.5 months). There was no significant difference between groups for any end point. The BUS group had fewer infections (4 vs 11), but the difference was not significant (p = 0.086, log-rank test). Gram-positive cocci were the most common culturable pathogens in the Chhabra group, while the only positive culture in the BUS group was a gram-negative rod. Conclusions These results provide equipoise for a randomized controlled trial in the same population and this has been initiated. It is possible that the observed trends may become significant in a larger study. The more complex task will involve determining not only the efficacy, but also the cost-effectiveness of using antibiotic-impregnated shunt components in limited-resource settings.

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Continuous Blood Purification on Influenza-associated Neurological Disease in Children: A Retrospective Cohort Study

10.21203/rs.3.rs-145075/v1 ◽

2021 ◽

Author(s):

Jingwen Ni ◽

Kenan Fang ◽

Zhe Zhao ◽

Zhiyuan Wang ◽

Qian Huang ◽

...

Keyword(s):

Cohort Study ◽

Intensive Care ◽

Retrospective Cohort Study ◽

Neurological Disease ◽

Retrospective Cohort ◽

Neurological Complications ◽

Inflammatory Factors ◽

Continuous Variables ◽

Exact Test ◽

Significant Difference

Abstract Background: Due to lack of proven therapies，we evaluated the effect of CBP on Influenza-Associated Neurological Disease in children.Methods: A single-center, retrospective, cohort study was conducted in Luoyang, Henan province China from January 2018 to January 2020. The children with Influenza-associated neurological disease (<18 years old) were enrolled into this study. The children with CBP indications and the parents’ consent received CBP, and the others were treated with maximal intensive care due to failure of parents consent. The outcomes were compared between CBP group and non-CBP group.Categorical variables were presented as percentage and compared by Chi-square test or Fisher’s exact test. Continuous variables were expressed as median (interquartile ranges) and compared with non-parametric independent sample test. Statistical analyses were finished by SPSS (version 26.0) and p < 0.05 (2 tailed) was considered statistically significant.Results: 30 influenza children with Influenza-associated neurological disease were enrolled in this study. 18 received CBP and other 12 were treated with maximal intensive care. There were no differences between CBP and non-CBP children in age, sex, body weight, type of influenza virus, neurological complications, Glasgow score, PIM-2 score and PCIS at admission (p > 0.05). The inflammatory factors (CRP, PCT and IL-6) of 30 cases were tested at admission and after 3 days of admission. In CBP group, the level of IL-6 decreased significantly at 3-day of admission (p = 0.003), the level of CRP and PCT also decreased, but there was no significant difference (p > 0.05). In the non-CBP group, there were no significant difference on level of CRP, PCT and IL-6 between at admission and 3-day of admission (p > 0.05). The 28-day mortality in the CBP group was significantly lower compared to non-CBP group (11.11% vs 50%, p = 0.034).Conclusions: CBP could Reduce inflammatory factors and may reduce 28-day mortality and improve neurologic function of influenza children.Trial registration: http://www.chictr.org.cn/index.aspx (ChiCTR2000031754).

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Associations between SARS-CoV-2 variants and risk of COVID-19 hospitalization among confirmed cases in Washington State: a retrospective cohort study

10.1101/2021.09.29.21264272 ◽

2021 ◽

Author(s):

Miguel I. Paredes ◽

Stephanie Lunn ◽

Michael Famulare ◽

Lauren A. Frisbie ◽

Ian Painter ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Sentinel Surveillance ◽

Cox Proportional Hazards Model ◽

Ancestral Lineage ◽

Significant Difference

Background: The COVID–19 pandemic is now dominated by variant lineages; the resulting impact on disease severity remains unclear. Using a retrospective cohort study, we assessed the risk of hospitalization following infection with nine variants of concern or interest (VOC/VOI). Methods: Our study includes individuals with positive SARS–CoV–2 RT PCR in the Washington Disease Reporting System and with available viral genome data, from December 1, 2020 to July 30, 2021. The main analysis was restricted to cases with specimens collected through sentinel surveillance. Using a Cox proportional hazards model with mixed effects, we estimated hazard ratios (HR) for the risk of hospitalization following infection with a VOC/VOI, adjusting for age, sex, and vaccination status. Findings: Of the 27,814 cases, 23,170 (83.3%) were sequenced through sentinel surveillance, of which 726 (3.1%) were hospitalized due to COVID–19. Higher hospitalization risk was found for infections with Gamma (HR 3.17, 95% CI 2.15–4.67), Beta (HR: 2.97, 95% CI 1.65–5.35), Delta (HR: 2.30, 95% CI 1.69–3.15), and Alpha (HR 1.59, 95% CI 1.26–1.99) compared to infections with an ancestral lineage. Following VOC infection, unvaccinated patients show a similar higher hospitalization risk, while vaccinated patients show no significant difference in risk, both when compared to unvaccinated, ancestral lineage cases. Interpretation: Infection with a VOC results in a higher hospitalization risk, with an active vaccination attenuating that risk. Our findings support promoting hospital preparedness, vaccination, and robust genomic surveillance.

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