David E. DeMik
University of Iowa
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Pharmacotherapy | 2013
Sammuel V. Anderegg; David E. DeMik; Barry L. Carter; Jeffrey D. Dawson; Karen B. Farris; Constance Shelsky; Peter J. Kaboli
To determine whether recommendations made by pharmacists and accepted by hospital physicians resulted in fewer postdischarge readmissions and urgent care visits compared with recommendations that were not implemented.
Journal of Arthroplasty | 2017
David E. DeMik; Nicholas A. Bedard; S. Blake Dowdle; Robert A. Burnett; Michael A. McHugh; John J. Callaghan
BACKGROUND The United States is in the midst of an opioid epidemic. These medications continue to be used to manage pain associated with osteoarthritis, despite mounting evidence questioning the benefits. The rate at which opioids are prescribed for osteoarthritis is largely unknown. We sought to identify rates of opioid prescriptions for osteoarthritis and identify factors associated with higher rates of prescribing. METHODS We queried the Humana, Inc. administrative claims database from 2007 to 2014. Patients with osteoarthritis were identified using International Classification of Diseases 9th Revision codes and classified as having hip, knee, or any joint osteoarthritis. Claims data were reviewed to identify opioid prescriptions associated with a diagnosis of osteoarthritis. Rates of prescribing were trended over time and stratified by sex, age, and geographic region. RESULTS From 2007 to 2014, 17.0% of patients with any joint osteoarthritis, 13.4% of patients with hip osteoarthritis, and 15.9% with knee osteoarthritis were prescribed an opioid for their condition. Yearly rates of prescription were fairly stable over this period. Patients in the South had the highest odds of opioid prescription, while those in the Northeast had the lowest. Patients ≤49 years old were more likely to receive a prescription than those ≥50 years old. CONCLUSION This study provides important epidemiologic data about the use of opioids for osteoarthritis. Despite increasing evidence calling proposed benefits into question and increasing awareness of risks of opioids, prescribing rates remained stable between 2007 and 2014. This provides important baseline data as we work to combat excessive and inappropriate opioid use within the United States.
Journal of Arthroplasty | 2017
Nicholas A. Bedard; Robert A. Burnett; David E. DeMik; Yubo Gao; Steve S. Liu; John J. Callaghan
BACKGROUND Bearing surface issues related to trunnionosis or metal-on-metal (MoM) articulations have likely impacted recent trends in bearing surface choice. The purpose of this study is to evaluate trends in total hip arthroplasty (THA) bearing surface use, including 2015 data, with respect to the date of operation and patient demographics. METHODS The Humana dataset was reviewed from 2007 through 2015 to analyze bearing surface usage in primary THA. Four bearing surface types were identified by International Classification of Disease, 10th Revision codes and trended throughout the years: metal-on-polyethylene (MoP), ceramic-on-ceramic (CoC), ceramic-on-polyethylene (CoP), and MoM. Prevalence was analyzed as a function of age and sex. RESULTS Of the 28,504 primary THA procedures, the most commonly used bearing was MoP (46.1%), followed by CoP (33.2%), MoM (17.1%), and ceramic-on-ceramic (3.6%). The use of CoP bearings significantly increased from 6.4% in 2007 to 52.0% in 2015, while MoM bearings decreased during this period. MoP bearings decreased over 2012-2015 (P < .001). CoP usage decreased with age, while MoP bearings increased with a transition occurring at 65-69 years of age. Women were more likely to receive MoP bearings (odds ratio [OR] 1.2), while men were more likely to receive MoM and CoP bearings (OR 1.1). Multivariate logistic regression showed age to be an independent predictor of bearing surface choice with patients 65 and older more likely to receive MoP bearings (OR 3.2). CONCLUSION Bearing surface choice in primary THA has changed tremendously from 2007 to 2015. MoM bearing use has decreased as a result of adverse effects. Age continues to remain a significant factor in bearing surface choice.
Journal of Bone and Joint Surgery-british Volume | 2018
Nicholas A. Bedard; David E. DeMik; S. B. Dowdle; John J. Callaghan
Aims The purpose of this study was to evaluate trends in opioid use after unicompartmental knee arthroplasty (UKA), to identify predictors of prolonged use and to compare the rates of opioid use after UKA, total knee arthroplasty (TKA) and total hip arthroplasty (THA). Materials and Methods We identified 4205 patients who had undergone UKA between 2007 and 2015 from the Humana Inc. administrative claims database. Post‐operative opioid use for one year postoperatively was assessed using the rates of monthly repeat prescription. These were then compared between patients with and without a specific variable of interest and with those of patients who had undergone TKA and THA. Results A total of 4205 UKA patients were analysed. Of these, 1362 patients (32.4%) were users of opioids. Pre‐operative opioid use was the strongest predictor of prolonged opioid use after UKA. Opioid users were 1.4 (81.6% versus 57.7%), 3.7 (49.5% versus 13.3%) and 5.5 (35.8% versus 6.5%) times more likely to be taking opioids at one, two and three months post‐operatively, respectively (p < 0.05 for all). Younger age and specific comorbidities such as anxiety/depression, smoking, back pain and substance abuse were found to significantly increase the rate of repeat prescription for opioids after UKA. Overall, UKA patients required significantly less opioid prescriptions than patients who had undergone THA and TKA. Conclusion One‐third of patients who undergo UKA are given opioids in the three months preoperatively. Pre‐operative opioid use is the best predictor of increased repeat prescriptions after UKA. However, other intrinsic patient characteristics are also predictive.
Orthopaedic Journal of Sports Medicine | 2017
Jessica Hanley; Chris A. Anthony; David E. DeMik; Natalie A. Glass; Annunziato Amendola; Brian R. Wolf; Matthew Bollier
Background: Management of the medial collateral ligament (MCL) in the setting of a multiligamentous knee injury (MLKI) represents an area of great controversy. Purpose: Our study was designed to compare long-term patient-reported outcomes (PROs) after MCL repair versus reconstruction in the setting of a multiligamentous injury of the knee. Study Design: Cohort study; Level of evidence, 3. Methods: At a single institution, 68 patients were identified over a 10-year period as having MCL intervention in the setting of MLKI. Of these patients, 34 (50%) were successfully contacted via telephone to collect Lysholm and International Knee Documentation Committee (IKDC) scores. A retrospective chart review of these subjects was also conducted to identify patient and surgical factors affecting PROs. Results: At a mean 6-year follow-up (range, 2-11 years), the mean Lysholm score was 77.4 ± 23.1 and mean IKDC score was 72.6 ± 23.6. Univariate analyses identified time to surgery (P = .005) and MCL reconstruction (P = .001) as risk factors for Lysholm score ≤75. Univariate analyses identified patient age (P = .049), time to surgery (P = .018), and MCL reconstruction (P = .004) as risk factors for IKDC score ≤75. On subsequent multivariate analysis, MCL reconstruction was found to be a predictor of Lysholm or IKDC score of ≤75. Conclusion: Patients undergoing MCL repair in the setting of MLKI generally had higher PROs than those undergoing reconstructions at a mean 6 years of follow-up. Further work is needed to elucidate patient and surgical factors that may influence subjective outcomes after multiligament knee injuries.
Journal of Arthroplasty | 2018
Nicholas A. Bedard; S. Blake Dowdle; Chris A. Anthony; David E. DeMik; Michael A. McHugh; Kevin J. Bozic; John J. Callaghan
[16] Bedard NA, Pugely AJ, Elkins JM, Duchman KR, Westermann RW, Liu SS, et al. The John N. Insall Award: do intraarticular injections increase the risk of infection after TKA? Clin Orthop Relat Res 2017;475:45e52, http://dx.doi.org/ 10.1007/s11999-016-4757-8. [17] Cancienne JM, Werner BC, Luetkemeyer LM, Browne JA. Does timing of previous intra-articular steroid injection affect the post-operative rate of infection in total knee arthroplasty? J Arthroplasty 2015;30:1879e82, http://dx.doi.org/ 10.1016/j.arth.2015.05.027.
Journal of Arthroplasty | 2018
Nicholas A. Bedard; David E. DeMik; Jessell M. Owens; Natalie A. Glass; Jennifer DeBerg; John J. Callaghan
BACKGROUND The purpose of this study was to perform a systematic review and meta-analysis to quantitatively assess the association between tobacco use and the risk of any wound complication and periprosthetic joint infection (PJI) after primary total hip and total knee arthroplasty procedures. METHODS Relevant articles published before January 2018 were identified by systematically searching PubMed, EMBASE, and Cochrane library databases. Pooled odds ratios (OR) and 95% confidence intervals were calculated for end points of any wound complication and PJI. Additional analyses were performed to evaluate risks between current, former, and non-tobacco users. RESULTS Fourteen studies were included in the meta-analysis. Tobacco users had a significantly higher risk of wound complications (OR, 1.78 [1.32-2.39]) and PJI (OR, 2.02 [1.47-2.77]) compared to non-tobacco users. Compared to non-tobacco users, there was an increased risk of PJI among current (OR, 2.16 [1.57-2.97] and former (OR, 1.52 [1.16-1.99]) tobacco users. Current tobacco users also had a significantly increased risk of PJI compared to former tobacco users (OR, 1.52 [1.07-2.14]). CONCLUSION Tobacco use before total hip and total knee arthroplasty significantly increases the risk of wound complications and PJI. This increased risk is present for both current and former tobacco users. However, former tobacco users had a significantly lower risk of wound complications and PJI compared to current tobacco users, suggesting that cessation of tobacco use before TJA can help to mitigate these observed risks.
Arthroplasty today | 2018
John J. Callaghan; David E. DeMik; Nicholas A. Bedard; Andrew N. Odland; William M. Kane; Steven M. Kurtz
Fracture of the tibial tray is a rarely observed complication of total knee arthroplasty (TKA), predominately in implants placed greater than a decade ago. This case highlights a case of baseplate fracture in a contemporary prosthesis. The patient presented 1 year after TKA with medial knee pain consistent with pes bursitis. The implant-cement-bone construct was intact and she was managed with corticosteroids. She had persistent pain, acutely developed new varus deformity, and presented with a tibial tray fracture. Retrieval analysis suggested fatigue fracture as the likely mechanism. At time of revision, necrotic bone was found at the medial plateau, which likely caused cantilever bending relative to the well-supported portion of the tray and resultant failure. The patient continues to do well 5 years after revision TKA.
Journal of Bone and Joint Surgery, American Volume | 2018
Nicholas A. Bedard; David E. DeMik; Natalie A. Glass; Robert A. Burnett; Kevin J. Bozic; John J. Callaghan
Journal of Arthroplasty | 2018
Nicholas A. Bedard; David E. DeMik; S. Blake Dowdle; Jessell M. Owens; Steve S. Liu; John J. Callaghan