Eugene Farng

Factors predicting complication rates after primary shoulder arthroplasty.

HYPOTHESIS Shoulder arthroplasty is an effective treatment for arthritic conditions and intraarticular fractures of the proximal humerus. Treatment options include total and hemiarthroplasty of the shoulder. They hypothesis of this study was that a mandatory statewide discharge database could identify the epidemiology of primary shoulder arthroplasty, 90 day complication rates, implant survival rates, and patient and hospital characteristics associated with complications. MATERIALS AND METHODS We identified patients undergoing primary total shoulder replacement and hemiarthroplasty between 1995 and 2005. We report rates of complications within 90 days of surgery and performed survival analysis using revision surgery as the endpoint. Logistic and proportional hazard regression models were used to estimate the effect of patient and provider factors in predicting the rates of adverse outcomes. RESULTS During the study period, 15,288 patients underwent shoulder arthroplasty. Patients undergoing total shoulder arthroplasty and hemiarthroplasty had no statistically significant difference in the aggregate risk of 90-day complications or the risk of implant failure within the study period. Fracture patients were shown to have a higher risk of short-term complications (odds ratio, 3.2; P < .001). Implant failure rates were lower in patients with fracture, rheumatoid arthritis, increased comorbidity, and advanced age. CONCLUSION This study reports similar rates of short-term complications and implant failure in patients undergoing total or hemiarthroplasty, an overall mortality rate of 1.3%, and a pulmonary embolism rate of 0.6%. The findings of our study indicate that the risk of short-term complications is highest in patients undergoing total or hemiarthroplasty for a fracture compared with nonfracture indications. Our results also indicate that longer-term, implant survival is largely driven by factors associated with increased activity, such as age. In patients undergoing surgery for arthritis of the shoulder, we found no difference in implant survival rates between total and hemiarthroplasty of the shoulder.

Complication and revision rates following total elbow arthroplasty.

PURPOSE To determine the complication rates after total elbow arthroplasty (TEA) in a large and diverse patient population. METHODS We identified patients undergoing TEA as inpatients in the years 1995 to 2005 using Californias Discharge Database. Short-term outcomes of interest included rates of infection or wound complications, revision, reoperation, and pulmonary embolism that were diagnosed during an inpatient hospital admission and mortality within 90 days of index surgery. Longer-term outcomes analyzed included rates of revision, amputation, and conversion to fusion. We used regression models to estimate the role of patient and provider characteristics in predicting the rates of adverse outcomes. RESULTS We identified 1,625 patients undergoing TEA. Early complications, defined as those requiring inpatient re-admission within the first 90 days after index surgery, were identified in 170 patients, and 132 patients required reoperation. Eighty one patients required revision in 90 days, and 48 underwent revision within one year. Early infections and wound complications requiring readmission occurred in 88 patients. In the 90 days after surgery, 4 patients had a pulmonary embolism and 10 patients died. One-hundred and twenty-one patients required revision, amputation, or fusion during the observation period, with a mean follow-up of 4 years. Hospital volume was not associated with increased risk of adverse outcomes. CONCLUSIONS We analyzed a large and diverse patient population undergoing TEA. The overall rate of short-term complications requiring inpatient treatment was high, at over 10% (170 patients), with almost 8% (132 patients) requiring reoperation within the first 90 days. Although population-based studies have shortcomings, they can add to the body of knowledge of less frequent procedures such as TEA. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.

Inter- and intra-observer reliability of the Baumann angle of the humerus in children with supracondylar humeral fractures

The Baumann angle of the humerus has been commonly used as an outcome measure for supracondylar fractures in children. However, there is limited or no information about the reliability of this measurement. The purpose of this study was to determine the inter-observer reliability (IEOR) and intra-observer reliability (IAOR) of the Baumann angle of the humerus. The Baumann angle of the humerus was measured by five observers on the anteroposterior radiographs of 35 children’s elbows, all of which had sustained a nondisplaced supracondylar humeral fracture. The values of IEOR and IAOR were calculated using a Pearson coefficient of correlation. Ranges of differences in the measurement of the Baumann angle of the humerus were established, and the percentage of agreement between observers was then calculated using those ranges. The Baumann angle of the humerus is a simple, repeatable and reliable measurement that can be used for the determination of the outcome of supracondylar humeral fractures in the paediatric population. An excellent IEOR was found for the measurement of the Baumann angle (r = 0.78, p = 0.0001). When the difference between observers in the reported measurement of the Baumann’s angle was calculated to be within seven degrees of each other, at least four of the five observers agreed 100% of the time. Similarly, excellent values of IAOR were found for the measurement of the Baumann’s angle (r = 0.80, p = 0.0001). Level of evidence for this study was III.

Complication rates following operative treatment of calcaneus fractures.

BACKGROUND The purpose of this study is to report the short-term complication rates and mid-term subtalar fusion rates following operative management of calcaneal fractures. METHODS This is a retrospective study of Californians undergoing operative treatment of a calaneus fracture from 1995 to 2005. The main outcomes reported are readmission for a short-term complication within 90 days of surgery and reoperation for subtalar fusion during the observation period. RESULTS We identified 4481 patients who underwent open reduction and internal fixation of their fracture as inpatients within 30 days of the index admission. The short-term rate of complications included a 90-day rate of readmission of 1.03% for wound infection, 0.25% for thromboembolic disease, and 0.22% for mortality. The mid-term rate of subtalar fusion was 3.49% at 5 years post-operatively. CONCLUSIONS This study reports the short-term complication rates and mid-term subtalar fusion rates following operative management of calcaneal fractures using population-based data.

Comparison of complication rates between hemiarthroplasty and total hip arthroplasty for intracapsular hip fractures.

Hip fractures are common and have come to represent an increasing burden of disease. As a result, it is critical that cost-effective and evidence-based treatments be used to treat hip fractures. However, with regard to hemiarthroplasty vs total hip arthroplasty (THA), the optimal treatment of displaced femoral neck fractures in elderly patients remains controversial. The purpose of this study was to compare complication rates after hemiarthroplasty and THA for intracapsular hip fractures.Data on hospitalizations from 1995 through 2005 were obtained from Californias Office of Statewide Health Planning and Development. Regression analyses were used to compare rates of short-term complications and mid-term revision surgeries following hemiarthroplasty and THA. The data identified 2437 patients undergoing THA and 38,328 undergoing hemiarthroplasty. At 90 days postoperatively, patients undergoing THA had no statistically significant increase in short-term complication risk compared with patients undergoing hemiarthroplasty (odds ratio, 0.89; P=.06). Cox regression analysis demonstrated no statistically significant difference in risk of revision surgery during the 11-year observation period.This study demonstrates similar short-term complication and mid-term revision risks following hemiarthroplasty and THA. This suggests that both procedures are safe alternatives, but further study is needed to clarify differences in functional outcomes and long-term revision rates for patients undergoing these procedures following a hip fracture.

Incidence of pulmonary embolism following surgical treatment of metatarsal fractures.

Background: The purpose of this study was to identify the rates of readmission to the hospital for pulmonary embolism following open reduction and internal fixation of metatarsal fractures using observational, population-based data from all inpatient admissions in California over an 11-year period. Materials and Methods: We identified patients undergoing open reduction and internal fixation of a metatarsal fracture in the years 1995 to 2005 as inpatients using Californias discharge database. The outcomes analyzed included readmission within 90 days of surgery for pulmonary embolism. Logistic regression models were used to estimate the impact of patient factors such as age, race/ethnicity and gender in predicting the rates of thromboembolic disease. Results: A total of 1,477 metatarsal ORIF procedures were performed as inpatients during the study period. We identified four patients (0.27%) readmitted with pulmonary embolism within 90 days of their initial ORIF procedure. There were three (0.20%) cases of mortality, none of which occurred in the four patients readmitted with pulmonary embolism. Given the low incidence, we did not identify age, gender, or race/ethnicity as statistically significant predictors of a higher risk of thromboembolic disease. Conclusion: The rate of readmission for pulmonary embolism was low. This suggests that the routine use of thromboprophylaxis may not be necessary for isolated metatarsal fractures to prevent pulmonary embolism. Level of Evidence: II, Prognostic Study