COVID-19 as a Catalyst for Same-Day Discharge Total Shoulder Arthroplasty

The COVID-19 pandemic caused major disruptions to the healthcare system, but its impact on the transition to same-day discharge shoulder arthroplasty remains unexplored. This study assessed the effect of COVID-19 on length of stay (LOS), same-day discharge rates, and other markers of resource use after elective total shoulder arthroplasty. A total of 508 consecutive patients undergoing elective primary total shoulder arthroplasty between 2019 and 2021 were identified and divided into 2 cohorts: “pre-COVID” (March 2019–March 2020; n = 263) and “post-COVID” (May 2020–March 2021; n = 245). No elective shoulder arthroplasties were performed at our practice between 18 March and 11 May 2020. Outcome measures included LOS, same-day discharge, discharge location, and 90-day emergency department (ED) visits, readmissions and reoperations. There were no significant differences in baseline preoperative patient characteristics. Shoulder arthroplasty performed post-COVID was associated with a shorter LOS (12 vs. 16 h, p = 0.017) and a higher rate of same-day discharge (87.3 vs. 79.1%, p = 0.013). The rate of discharge to skilled nursing facilities was similarly low between the groups (1.9 vs. 2.0%, p = 0.915). There was a significant reduction in the rate of 90-day ED visits post-COVID (7.4 vs. 13.3%, p = 0.029), while there were no differences in 90-day reoperation (2.0 vs. 1.5%, p = 0.745) or readmission rates (1.2 vs. 1.9%, p = 0.724). The COVID-19 pandemic seems to have accelerated the shift towards shorter stays and more same-day discharge shoulder arthroplasties, while reducing unexpected acute health needs (e.g., ED visits) without adversely affecting readmission and reoperation rates.

Describing agreement in the Main Condition coding field using Canadian ICD-11 inpatient data

IntroductionCountries use varying coding standards, which impact international coded data comparability. The `main condition' (MC) field is coded within the Discharge Abstract Database as "reason for admission" or "largest resource use". ObjectiveWe offer a preliminary analysis on the frequency of and contributing factors to MC definition agreements within an inpatient Canadian dataset. MethodsSix professional coders performed a chart review between August 2016 and June 2017 on 3,000 randomly selected inpatient charts from three acute care hospitals in Calgary, Alberta. Coders classified the MC as "reason for admission", "largest resource use" or "both". Patients were admitted between 1st January and 30th June 2015 and met the inclusion criteria if they were >18 years, had an Alberta personal health care number, and had an inpatient visit for any service outside of obstetrics. Agreement between the two MC definitions was stratified by length of stay (LOS), emergency department admission, hospital of origin, discharge location, age, sex, procedures, and comorbidities. Chi-square analysis and frequency of inconsistencies were reported. ResultsOnly 34 (1.51%) of the 2,250 patient charts had disagreeing MC definitions. Age, emergency visit on admit, LOS, hospital, and discharge location were associated with MC agreement. Chronic conditions were seen more often in MC definition agreements, and acute conditions seen within those disagreeing. ConclusionThere was a small proportion of cases in which the condition bringing the patient to hospital was not also the condition occupying the largest resources. Within disagreements, further research using a larger sample size is needed to explore the presence of MC in a secondary/tertiary condition, the association between patient complexity and disagreeing MC definitions, and the nature of the conditions seen in the inconsistent MC definitions.

Hydrogeochemical Evolution of an Aquifer Regulated by Pyrite Oxidation and Organic Sediments

Detailed full-scale groundwater monitoring was carried out over a period of nine years, sampling at selected points along the groundwater flow direction in its final stretch. This established the hydrogeochemical evolution along the flow of a natural system formed by a calcareous aquifer which discharges and then passes through a quaternary aquifer of lake origin which is rich in organic matter. This evolution is highly conditioned by the oxidation of pyrites that are abundant in both aquifers. In the first aquifer, one kilometre before the discharge location, oxidizing groundwater crosses a pyrite mineralization zone whose oxidation produces an important increase in sulphates and water denitrification over a short period of time. In the quaternary aquifer with peat sediments and pyrites, water experiences, over a small 500 m passage and residence time of between three and nine years, a complete reduction by way of pyrite oxidation, and a consequent increase in sulphates and the generation of hydrogen sulphuric acid. This is an example of an exceptional natural hydrogeological environment which provides guidance on hydrogeochemical processes such as denitrification.

Burn Patient Insurance Status Influences Hospital Discharge Disposition and Utilization of Post-Discharge Outpatient Care

Post-discharge services, such as outpatient wound care, may affect long term health outcomes and post-recovery quality of life. Access to these services may vary according to insurance status and ability to withstand out-of-pocket expenses. Our objective was to compare discharge location between burn patients who were uninsured, publicly insured, or privately insured at the time of their burn unit admissions. A retrospective review from July 1, 2015 to November 1, 2019 was performed at an ABA-verified burn center. All inpatient burn admission patients were identified and categorized according to insurance payer type. The primary outcome was discharge location, and secondary outcomes included readmission and outpatient burn care attendance. In total, 284 uninsured, 565 publicly insured and 293 privately insured patients were identified. There were no significant differences in TBSA (P=0.3), inhalation injury (P=0.3), ICU days (P=0.09), or need for grafting (P=0.1). For primary outcome, uninsured patients were more likely to be discharged without ancillary services(P<0.0001). Publicly insured patients were more likely to receive skilled nursing care (P=0.0007). Privately insured patients were more likely to receive homecare (P=0.0005) or transfer for ongoing inpatient care (P<0.0001). There was no difference in burn unit readmission (P=0.5); uninsured were more likely to follow up with outpatient burn clinic after discharge (P=0.004). Uninsured patients were less likely to receive post-discharge resources. Uninsured patients receive fewer post-discharge wound care resources which could result in suboptimal long-term results, and diminished return to pre-injury functional status. Increased access to post-discharge resources will provide comprehensive care to more patients.

Osteosynthesis of non-displaced femoral neck fractures in the elderly population using the femoral neck system (FNS): short-term clinical and radiological outcomes

Background Femoral neck fractures (FNF) are frequent in the elderly population, and surgical management is indicated in the vast majority of cases. Osteosynthesis is an alternative to arthroplasty for non-displaced FNF. Triple screw construct (TS) and the dynamic hip screw system (DHS) are considered gold standards for osteosynthesis. The newly available femoral neck system (FNS) currently lacks evidence as to whether it is a valid alternative to TS and DHS. The purpose of this study was to evaluate the short-term clinical and radiological outcomes after non-displaced (Garden I and II) FNF osteosynthesis using TS, DHS, and FNS. Methods All the patients of the author’s institution aged ≥ 75 years with a non-displaced (Garden I and II) FNF eligible for osteosynthesis between November 2015 and December 2019 were included in this single-center retrospective non-randomized study. Patients were treated with either TS, DHS, or FNS depending on the surgeon’s preference. Clinical data (age, gender, ASA score, duration of surgery, need for blood transfusion and number of packed red blood cells transfused, surgical site complications, length of stay, discharge location, postoperative medical complications and readmission within 30 days, and mortality within 3 months) were extracted from the patients’ charts. The radiological analysis assessed the fracture classification, fracture impaction, and proximal femur shortening at 3 and 6 months using the institutional imaging software. Results Baseline characteristics in the TS (n = 32), DHS (n = 16), and FNS (n = 15) groups were similar with respect to age (mean 85 years), gender (female to male ratio 4:1), and ASA score. There were no significant differences across the groups for the need for blood transfusion, surgical site complications, length of stay, postoperative medical complications and readmission within 30 days, discharge location, and mortality within 3 months. The duration of surgery was significantly lower in the FNS group (43.3 vs 68.8 min; p < 0.001). The radiological assessment found similar impaction (5.2 mm ± 4.8) and shortening (8.6 mm ± 8.2) in all groups that did not seem to progress after 3 months. Conclusion The FNS appears to be a valid alternative implant for FNF osteosynthesis and is associated with a shorter operative time than TS and DHS. Short-term clinical and radiological outcomes of FNS are similar to TS and DHS implants. Further long-term multicenter randomized studies are however necessary to confirm these first results.