scholarly journals Do standards of care and early outcomes of periprosthetic fractures change during the COVID-19 pandemic? A multicentre study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Luigi Zagra ◽  
Rocco D’Apolito ◽  
Nicola Guindani ◽  
Giovanni Zatti ◽  
Fabrizio Rivera ◽  
...  
Keyword(s):  
Periprosthetic Fractures ◽  
Standards Of Care ◽  
Pain Visual Analogue Scale ◽  
Level Of Evidence ◽  
Clinical Frailty Scale ◽  
Asa Score ◽  
Operative Complications ◽  
American Society ◽  
Surgical Treatments ◽  
Unified Classification System

Abstract Background Periprosthetic fractures (PPFs) are a growing matter for orthopaedic surgeons, and patients with PPFs may represent a frail target in the case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The purpose of this study is to investigate whether hospital reorganisations during the most severe phase of the SARS-CoV-2 pandemic affected standards of care and early outcomes of patients treated for PPFs in Northern Italy. Materials and methods Data were retrieved from a multicentre retrospective orthopaedics and traumatology database, including 14 hospitals. The following parameters were studied: demographics, results of nasopharyngeal swabs, prevalence of coronavirus disease 2019 (COVID-19), comorbidities, general health status (EQ-5D-5L Score), frailty (Clinical Frailty Scale, CFS), pain (visual analogue scale, VAS), anaesthesiologic risk (American Society of Anaesthesiology Score, ASA Score), classification (unified classification system, UCS), type of operation and anaesthesia, in-hospital and early complications (Clavien–Dindo Classification, CDC), and length of stay (LOS). Data were analysed by means of descriptive statistics. Out of 1390 patients treated for any reason, 38 PPFs were included. Results Median age was 81 years (range 70–96 years). Twenty-three patients (60.5%) were swabbed on admission, and two of them (5.3%) tested positive; in three patients (7.9%), the diagnosis of COVID-19 was established on a clinical and radiological basis. Two more patients tested positive post-operatively, and one of them died due to COVID-19. Thirty-three patients (86.8%) presented a proximal femoral PPF. Median ASA Score was 3 (range, 1–4), median VAS score on admission was 3 (range, 0–6), median CFS was 4 (range, 1–8), median EQ-5D-5L Score was 3 in each one of the categories (range, 1–5). Twenty-three patients (60.5%) developed post-operative complications, and median CDC grade was 3 (range, 1–5). The median LOS was 12.8 days (range 2–36 days), and 21 patients (55.3%) were discharged home. Conclusions The incidence of PPFs did not seem to change during the lockdown. Patients were mainly elderly with comorbidities, and complications were frequently recorded post-operatively. Despite the difficult period for the healthcare system, hospitals were able to provide effective conventional surgical treatments for PPFs, which were not negatively influenced by the reorganisation. Continued efforts are required to optimise the treatment of these frail patients in the period of the pandemic, minimising the risk of contamination, and to limit the incidence of PPFs in the future. Level of evidence IV.

scholarly journals Regional variations in the treatment of gallstone disease may affect patient outcome: A large, population-based register study in sweden

2020 ◽  
pp. 145749692096801
Author(s):  
L. Lindqvist ◽  
G. Sandblom ◽  
P. Nordin ◽  
O. Hemmingsson ◽  
L. Enochsson
Keyword(s):  
Population Density ◽  
Gallstone Disease ◽  
Large Population ◽  
Treatment Strategies ◽  
Population Based ◽  
Standards Of Care ◽  
Geographical Regions ◽  
Operative Complications ◽  
American Society ◽  
Post Operative Complications

Background: The lack of studies showing benefit from surgery in patients with symptoms of gallstone disease has led to a divergence in local practices and standards of care. This study aimed to explore regional differences in management and complications in Sweden. Furthermore, to study whether population density had an impact on management. Methods: Data were collected from the Swedish National Register for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks). Cholecystectomies undertaken for gallstone disease between January 2006 and December 2017 were included. Age, sex, American Society of Anesthesiologists (ASA) classification, intra- and post-operative complications, and the proportion of patients with acute cholecystitis who underwent surgery within 2 days of hospital admission were analyzed. The 21 different geographical regions in Sweden were compared, and each variable was analyzed according to population density. Results: A total of 139,444 cholecystectomies cases were included in this study. There were large differences between regions regarding indications for surgery and intra- and post-operative complications. In the analyses, there were greater divergences than would be expected by chance for most of the variables analyzed. Age of the cholecystectomized patients correlated with population density of the regions (R2 = 0.310; p = 0.0088). Conclusion: There are major differences between the different regions in Sweden in terms of the treatment of gallstone disease and outcome, but these did not correlate to population density, suggesting that local routines are more likely to have an impact on treatment strategies rather than demographic factors. These differences need further investigation to reveal the underlying causes.

scholarly journals Union rates and functional outcome of double plating of the femur: systematic review of the literature

2021 ◽  
Author(s):  
M. F. Lodde ◽  
M. J. Raschke ◽  
J. Stolberg-Stolberg ◽  
J. Everding ◽  
S. Rosslenbroich ◽  
...  
Keyword(s):  
Systematic Review ◽  
Fracture Healing ◽  
Functional Outcome ◽  
Femoral Fractures ◽  
Periprosthetic Fractures ◽  
Level Of Evidence ◽  
Distal Femoral Fractures ◽  
Femur Fractures ◽  
Meta Analyses ◽  
Double Plating

Abstract Background The optimal treatment strategy for the surgical management of femur fractures and non-unions remains unknown. The aim of this study is to assess union rates, complications and outcome after femoral double plating. Treatment of shaft, distal, periprosthetic fractures and pathological proximal femur fractures as well as femoral non-unions with double plating were evaluated. Methods A systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was conducted. Published literature reporting on the treatment and clinical outcome of femoral fractures and non-unions with double plating was identified. In total, 24 studies with 436 cases of double plating, 64 cases of single plating, 84 cases of intramedullary nailing (IM), and 1 interfragmentary screw treatment met the inclusion criteria of this systematic review. The evaluated literature was published between 1991 and 2020. Results Double plating of femoral fractures achieved high healing rates and few complications were reported. It displayed significantly less intraoperative haemorrhage, shorter surgery time reduced risk of malunion in polytraumatised patients when compared to IM. Fracture healing rate of double-plating distal femoral fractures was 88.0%. However, there were no significant differences regarding fracture healing, complication or functional outcome when compared to single plating. Treatment of periprosthetic fractures with double plating displayed high healing rates (88.5%). Double plating of non-unions achieved excellent osseous union rates (98.5%). Conclusions The literature provides evidence for superior outcomes when using double plating in distal femoral fractures, periprosthetic fractures and femoral non-unions. Some evidence suggests that the use of double plating of femoral fractures in polytraumatised patients may be beneficial over other types of fracture fixation. Level of evidence IV.

Breast Cancer Care: Developments in 1998

1998 ◽  
Vol 5 (4) ◽  
pp. 338-345
Author(s):  
John Horton
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Metastatic Breast ◽  
The United States ◽  
Axillary Node ◽  
Standards Of Care ◽  
Sources Of Information ◽  
Breast Cancer Care ◽  
Mortality And Morbidity ◽  
American Society

Background Breast cancer is a significant cause of mortality and morbidity worldwide, although death rates in the United States and some other countries are beginning to fall. Methods Several sources of information in 1998, including publications and presentations at the 1998 meeting of the American Society of Clinical Oncology, are pertinent to contemporary breast cancer care. Results It is now possible to prescribe hormonal therapy that will reduce the incidence of breast cancer. Methods are available to reduce the morbidity from axillary node dissection, and improvements in adjuvant therapy and management of metastatic breast cancer are now at hand. Conclusions The information presented provides a broad-based platform for new standards of care for breast cancer that will serve as a sound base for further progress in this important disease.

A new surgical technique for the treatment of scaphotrapezial arthritis associated with trapeziometacarpal arthritis: the narrow pseudoarthrosis

2016 ◽  
Vol 41 (7) ◽  
pp. 710-718 ◽  
Author(s):  
M. Rubino ◽  
L. Cavagnaro ◽  
V. Sansone
Keyword(s):  
Simple Technique ◽  
Stage Iv ◽  
Pinch Strength ◽  
Dash Score ◽  
Level Of Evidence ◽  
First Ray ◽  
Excision Arthroplasty ◽  
Surgical Treatments ◽  
New Surgical Technique

We describe a technique for treating Eaton stage IV osteoarthritis of the first ray, which is a development of our previously published technique for treating trapeziometacarpal arthritis. This simple technique is based on a limited resection arthroplasty of the first trapeziometacarpal and the scaphotrapezial joints, with the aim of inducing the formation of a narrow pseudoarthrosis at both sites. A total of 26 consecutive patients were treated for Eaton stage IV arthritis at a mean follow-up of 4.7 years (range 3.2–6.6). There were statistically significant improvements in all clinical parameters: mean appositional and oppositional pinch strength, mean DASH score (65 points pre-operatively to 8.7 points at final follow-up), and in mean visual analogue scale score (8.6 to 0.2 points). Although a larger cohort and a longer follow-up will be necessary to evaluate this new technique fully, these results encourage us to believe that the limited excision arthroplasty of the trapeziometacarpal and scaphotrapezial joints is a viable alternative to the existing surgical treatments for stage IV thumb arthritis. Level of evidence: 4

scholarly journals SURVIVAL OF NONAGENARIAN PATIENTS WITH HIP FRACTURES: A COHORT STUDY

2017 ◽  
Vol 25 (4) ◽  
pp. 132-136 ◽  
Author(s):  
Alexa Ovidiu ◽  
Gheorghevici Teodor Stefan ◽  
Popescu Dragos ◽  
Veliceasa Bogdan ◽  
Alexa Ioana Dana
Keyword(s):  
Internal Fixation ◽  
Hip Fractures ◽  
Survival Data ◽  
Demographic Data ◽  
Level Of Evidence ◽  
Asa Score ◽  
Kaplan Meier ◽  
Trochanteric Region ◽  
One Year ◽  
Retrospective Comparative Study

ABSTRACT Objective: The objective of this study was to assess survival and factors that may influence survival in nonagenarians with hip fracture. Methods: We retrospectively analyzed 134 nonagenarian patients admitted for hip fractures over a period of 9 years, and reviewed medical records and survival data from the National Population Register. The analysis included demographic data, ASA score, surgical delay, type of treatment, and mortality. Results: Mean patient age was 92.53 years (range 90-103 years). Of the total, 35.8% of the fractures involved the femoral neck and 64.2% were in the trochanteric region. Overall mortality was 18.7% at 30 days, and 9% at one year. Mean survival for the entire sample was 683±78.1 days, with a median of 339 days; survival in men and women was 595±136.8 days and 734±94.6 days, respectively. We found that type of fracture (p=0.026) and ASA score (p=0.004) were the main factors influencing survival. Kaplan-Meier survival analysis indicated that patients with extracapsular fractures treated by internal fixation had a better survival rate (p=0.047). There was no significant differences between sexes (p = 0.102) or diagnosis (p = 0.537) Conclusion: Although nonagenarian patients have numerous comorbidities, surgical treatment using internal fixation seems superior to a conservative approach. Level of Evidence III, Retrospective Comparative Study.

scholarly journals Morbidity and mortality after fragility hip fracture in a Saudi Arabian population: Report from a single center

2017 ◽  
Vol 45 (3) ◽  
pp. 1175-1180 ◽  
Author(s):  
Mir Sadat-Ali ◽  
Moaad Alfaraidy ◽  
Abdulaziz AlHawas ◽  
Ahmed Abdallah Al-Othman ◽  
Dakheel A Al-Dakheel ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Mortality Rate ◽  
Demographic Data ◽  
Femoral Fractures ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Fragility Hip Fracture ◽  
Asa Score ◽  
Telephone Interviews ◽  
American Society

Objective To determine the functional morbidity and mortality after fragility hip fracture and compare the mortality with three other common diseases. Methods Data were collected from patients admitted to King Fahd Hospital of the University, AlKhobar from January 2010 to December 2014. Demographic data included the preoperative American Society of Anesthesiologists (ASA) score as assessed by the anesthetist and the type of surgery. Personal and telephone interviews were performed, and data were entered into a database and analyzed. Results We identified 203 patients with fragility proximal femoral fractures, and the data of 189 patients (109 male, 80 female; average age, 66.90 ± 13.43 years) were available for analysis. The overall mortality rate was 26.98% (51 patients). The mortality rate was significantly higher among patients with an ASA score of 4 (36.36%) than 1 (20.45%). With respect to morbidity, only 48.23% of patients were able to return to their pre-fracture status; 32.35% of those who required assisted walking and 83.4% of those who required a wheelchair became bedridden. Conclusions Our data demonstrate that patients with fragility hip fractures have high morbidity and a mortality rate approaching 30%. Age and the ASA score significantly influence this high mortality rate.

scholarly journals Stroke Rehabilitation - An Overview of Existing Guidelines and Standards of Care

2011 ◽  
Vol 6 (3) ◽  
pp. 170 ◽  
Author(s):  
Richard D Zorowitz ◽  
Keyword(s):  
Stroke Rehabilitation ◽  
Healthcare Providers ◽  
Standards Of Care ◽  
Interdisciplinary Management ◽  
Stroke Survivors ◽  
Level Of Evidence ◽  
The Us ◽  
Guidelines And Standards ◽  
Complications Of Stroke ◽  
The Uk

Over seven million stroke survivors live in the US today. Despite the publication of the first post-stroke rehabilitation clinical practice guideline in 1995, many healthcare providers are unaware not only of stroke survivors’ potential for functional recovery, but also common secondary complications of stroke. This article summarises the best available evidence-based recommendations for the interdisciplinary management of stroke survivors and caregivers from five sources: two in the US, one in Canada, and two in the UK. Unique characteristics of each guideline are described, followed by a list of common clinical recommendations found in most, if not all, of the guidelines. Despite the advances in stroke rehabilitation over the past 16 years, much research still needs to be done to improve the level of evidence in stroke rehabilitation.

scholarly journals Discordant American Society of Anesthesiologists Physical Status Scoring between Anesthesiologists and Surgeons Is Correlated With Adverse Patient Outcomes: A Retrospective Cohort Study of 46284 Elective Surgical Patients

2021 ◽  
Author(s):  
Charlene Xian Wen Kwa ◽  
Jiaqian Cui ◽  
Daniel Yan Zheng Lim ◽  
Yilin Eileen Sim ◽  
Yuhe Ke ◽  
...  
Keyword(s):  
Cohort Study ◽  
Patient Outcomes ◽  
Real World ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Clinical Factors ◽  
Physical Status ◽  
Asa Score ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract BackgroundThe American Society of Anesthesiologists Physical Status Classification (ASA) score is used for communication of patient health status, risk scoring, benchmarking and financial claims. Prior studies using hypothetical scenarios have shown poor concordance of ASA scoring among healthcare providers. However, there is a paucity of concordance studies using real-world data, as well as studies of clinical factors or patient outcomes associated with discordant scoring. The study aims to assess real-world ASA score concordance between surgeons and anesthesiologists, factors surrounding discordance and its impact on patient outcomes. MethodsThis retrospective cohort study was conducted in a tertiary academic medical center on 46284 consecutive patients undergoing elective surgery between January 2017 and December 2019. ASA scores entered by surgeons and anesthesiologists, patient demographics, and post-operative outcomes were collected. We assessed the concordance of preoperative ASA scoring between surgeons and anesthesiologists, clinical factors associated with score discordance, the impact of score discordance on clinically important outcomes, and the discriminative ability of the two scores for 30-day mortality, 1-year mortality, and intensive care unit (ICU) admission. Statistical tests used included Cohen’s weighted 𝜅 score, chi-square test, t-test, unadjusted odds ratios and logistic regression models. ResultsThe ASA score showed moderate concordance (weighted Cohen’s 𝜅 0.53) between surgeons and anesthesiologists. 15098 patients (32.6%) had discordant scores, of which 11985 (79.4%) were scored lower by surgeons. We found significant associations between discordant scores and anesthesiologist-assessed comorbidities, patient age and race. Patients with discordant scores had a higher risk of 30-day mortality (odds ratio 2.00, 95% confidence interval [CI] = 1.52-2.62, p<0.0001), 1-year mortality (odds ratio 1.53, 95% CI = 1.38-1.69, p < 0.0001), and ICU admission >24 hours (odds ratio 1.69, 95% CI = 1.47-1.94, p< 0.0001), and stratified analyses showed a trend towards higher risk when the surgeons’ ASA score was lower. ConclusionsThere is moderate concordance between surgeons and anesthesiologists in assigning the ASA classification. Discordant ASA scores are associated with adverse patient outcomes. Hence, there is a need for improved standardization of ASA scoring and cross-specialty review in ASA-discordant cases.

scholarly journals Chondrosarcoma of bone in children and adolescents

2020 ◽  
Vol 14 (4) ◽  
pp. 330-334
Author(s):  
Yoichi Kaneuchi ◽  
Tomohiro Fujiwara ◽  
Yusuke Tsuda ◽  
Shinichirou Yoshida ◽  
Jonathan D. Stevenson ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Young Patients ◽  
Good Prognosis ◽  
Level Of Evidence ◽  
Biological Behaviour ◽  
Children And Adolescent ◽  
Grade Ii ◽  
Surgical Treatments ◽  
Ray Amputation

Purpose Chondrosarcomas typically present in adults during the fifth to seventh decades and are rare in young patients. The biological behaviour and oncological outcomes may be different in children and adolescents. Methods We retrospectively evaluated the outcomes of all patients with chondrosarcoma of bone who were younger than 18 years of age at the time of diagnosis and were treated at our centre between 1995 and 2018. Results The 15 consecutive patients studied included nine male and six female cases, with a mean age at diagnosis of 13 years (7 to 17). The median follow-up was 117 months (30 to 277). The tumours were primary and secondary in ten and five patients, respectively. The tumours were central in 13 and surface in two patients. The tumour locations were the humerus in five, digits in five, femur in three, radius in one and pelvis in one patient. The histological grades were grade I in seven, grade II in seven and grade III in one patient. The surgical treatments were limb salvage in ten patients and ray amputation in five patients. The surgical margins were wide in eight, marginal in two and intralesional in five patients. All the patients were alive and continuously free of disease at the time of the last follow-up. No patient developed metastases or local recurrence. Conclusion Chondrosarcoma of bone in children and adolescent patients has a very good prognosis and is less aggressive compared with published outcomes in older patients. Level of evidence IV

Partial trapeziectomy and pyrocarbon interpositional arthroplasty for trapeziometacarpal osteoarthritis: minimum 8-year follow-up

2020 ◽  
Vol 45 (5) ◽  
pp. 472-476 ◽  
Author(s):  
Francesco Smeraglia ◽  
Sergi Barrera-Ochoa ◽  
Gerardo Mendez-Sanchez ◽  
Morena A. Basso ◽  
Giovanni Balato ◽  
...  
Keyword(s):  
Young Patients ◽  
Hand Surgery ◽  
Dash Score ◽  
Level Of Evidence ◽  
Interpositional Arthroplasty ◽  
Trapeziometacarpal Osteoarthritis ◽  
Select Group ◽  
Trapeziometacarpal Joint Osteoarthritis ◽  
Surgical Treatments

We undertook a retrospective study to evaluate minimal 8-year outcomes of 46 trapeziometacarpal joints (46 patients) treated with pyrocarbon implant arthroplasty after partial trapeziectomy for trapeziometacarpal joint osteoarthritis in two different hand surgery units. The mean follow-up interval was 9.5 years (average 113 months with a range 97–144 months). The study showed that pyrocarbon interpositional arthroplasty provided pain relief and high patient satisfaction. All patients experienced a reduction in the DASH score, with an average change of 30 points. The visual analogue scale score, the Kapandji score, and key pinch also showed remarkable improvement. The PyroDisk implant exhibited good longevity, with good implant survival. A review of the literature revealed that the functional outcomes after implant surgery are not superior to more common techniques, such as trapeziectomy with or without ligamentoplasty. Therefore, this is a reliable surgery but may not have added benefits over simpler surgical treatments. This implant could have a role, perhaps in a select group of young patients, as a time-procuring procedure. Level of evidence: IV

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