Jimmy J. Jiang

Analysis of Pitching Velocity in Major League Baseball Players Before and After Ulnar Collateral Ligament Reconstruction

Background: Ulnar collateral ligament (UCL) reconstructions are relatively common among professional pitchers in Major League Baseball (MLB). To the authors’ knowledge, there has not been a study specifically analyzing pitching velocity after UCL surgery. These measurements were examined in a cohort of MLB pitchers before and after UCL reconstruction. Hypothesis: There is no significant loss in pitch velocity after UCL reconstruction in MLB pitchers. Study Design: Cohort study; Level of evidence, 3. Methods: Between the years 2008 to 2010, a total of 41 MLB pitchers were identified as players who underwent UCL reconstruction. Inclusion criteria for this study consisted of a minimum of 1 year of preinjury and 2 years of postinjury pitch velocity data. After implementing exclusion criteria, performance data were analyzed from 28 of the 41 pitchers over a minimum of 4 MLB seasons for each player. A pair-matched control group of pitchers who did not have a known UCL injury were analyzed for comparison. Results: Of the initial 41 players, 3 were excluded for revision UCL reconstruction. Eight of the 38 players who underwent primary UCL reconstruction did not return to pitching at the major league level, and 2 players who met the exclusion criteria were omitted, leaving data on 28 players available for final velocity analysis. The mean percentage change in the velocity of pitches thrown by players who underwent UCL reconstruction was not significantly different compared with that of players in the control group. The mean innings pitched was statistically different only for the year of injury and the first postinjury year. There were also no statistically significant differences between the 2 groups with regard to commonly used statistical performance measurements, including earned run average, batting average against, walks per 9 innings, strikeouts per 9 innings, and walks plus hits per inning pitched. Conclusion: There were no significant differences in pitch velocity and common performance measurements between players who returned to MLB after UCL reconstruction and pair-matched controls.

Comparison of perioperative complications and hospitalization outcomes after ankle arthrodesis versus total ankle arthroplasty from 2002 to 2011.

Background: The aim of this study was to analyze a validated, nationally representative admissions database in order to compare perioperative complications and hospitalization outcomes associated with ankle arthrodesis (AAD) versus ankle arthroplasty (TAA). Methods: Using the Nationwide Inpatient Sample (NIS) database from 2002 to 2011, 12 250 patients who underwent AAD and 3002 patients who underwent TAA were identified based on International Classification of Diseases, Ninth Revision (ICD-9) codes. The demographics, comorbidities, and perioperative outcomes during the index hospital stay were compared between patients who underwent AAD and TAA. Multivariate analysis was performed to adjust for differences in demographics and comorbidities between the 2 groups. Results: Multivariate analysis demonstrated that TAA was independently associated with a decreased risk of blood transfusion (relative risk [RR] = 0.53, P < .001), non–home discharge (RR = 0.70, P < .001), and overall complication (RR = 0.79, P = .03). There were similar rates of pneumonia, deep vein thrombosis, pulmonary embolus, cerebrovascular accident, myocardial infarction, and mortality. TAA was independently associated with a significantly higher hospital charge (difference =

Obesity is Not Associated with Increased Short-term Complications After Primary Total Shoulder Arthroplasty.

24 431, P < .001). There was no significant difference in the adjusted length of stay between the 2 groups (P = .13). Conclusion: TAA was independently associated with a lower risk of blood transfusion, non–home discharge, and overall complication when compared to AAD during the index hospitalization period. TAA was also independently associated with a higher hospitalization charge, but length of stay was similar between the 2 groups. Until long-term comparative studies are performed, the optimal treatment for end-stage ankle arthritis remains controversial, this study provides greater clarity with regard to hospitalization outcomes after the 2 procedures and shows no significant difference in risk for the majority of medical perioperative complications. Level of Evidence: Level III, comparative series.

Risk Factors for Complications Following Open Reduction Internal Fixation of Distal Radius Fractures

BackgroundFew studies have analyzed the association between elevated BMI and complications after total shoulder arthroplasty (TSA). Previous studies have not consistently arrived at the same conclusion regarding whether obesity is associated with a greater number of postoperative complications. We used a national surgical database to compare the 30-day complication profile and hospitalization outcomes after primary TSA among patients in different BMI categories.Questions/purposesWe asked: (1) Is obesity associated with an increased risk of complications within 30 days of primary TSA? (2) Is obesity associated with increased operative time?MethodsThe American College of Surgeons National Surgical Quality Improvement Program® database for 2006 to 2012 was queried to identify all patients who underwent a primary TSA for osteoarthritis of the shoulder. The ACS-NSQIP® database was selected for this study as it is a nationally representative database that provides prospectively collected perioperative data and a comprehensive patient medical profile. Exclusion criteria included revision TSA, infection, tumor, or fracture. We analyzed 4796 patients who underwent a primary TSA for osteoarthritis of the shoulder. Patients who underwent a TSA were divided in four BMI categories: normal (18.5–25 kg/m2), overweight (25–30 kg/m2), obesity Class 1 (30–35 kg/m2), and obesity Class 2 or greater (> 35 kg/m2). Perioperative hospitalization data and 30-day postoperative complications were compared among different BMI classes. Differences in patient demographics, preoperative laboratory values, and preexisting patient comorbidities also were analyzed among different BMI groups, and multivariate analysis was used to adjust for any potential confounding variables.ResultsThere was no association between BMI and 30-day complications after surgery (normal as reference, overweight group relative risk: 0.57 [95% CI, 0.30–1.06], p = 0.076; obesity Class 1 relative risk: 0.52 [95% CI, 0.26–1.03], p = 0.061; obesity Class 2 or greater relative risk: 0.54 [95% CI, 0.25–1.17], p = 0.117). However, greater BMI was associated with longer surgical times (for normal BMI control group: 110 minutes, SD, 42 minutes; overweight group: 115 minutes, SD, 46 minutes, mean difference to control: 5 minutes [95% CI, −1 to 10 minutes], p = 0.096; obesity Class 1: 120 minutes, SD, 43 minutes, mean difference: 10 minutes [95% CI, 5–15 minutes], p < 0.001; obesity Class 2 or greater: 122 minutes, SD, 45 minutes, mean difference: 12 minutes [95% CI, 6–18 minutes], p < 0.001).ConclusionsAlthough the surgical time increased for patients with greater BMI, the 30-day complications and perioperative hospitalization data after TSA were not different in patients with increased BMI levels. Obesity alone should not be a contraindication for TSA, and obese patients can expect similar incidences of postoperative complications. The preoperative medical optimization plan should be consistent with that of patients who are not obese who undergo TSA.Level of EvidenceLevel III, therapeutic study.

Effect of Diabetes Mellitus on Perioperative Complications and Hospital Outcomes After Ankle Arthrodesis and Total Ankle Arthroplasty

PURPOSE A national surgical database was used to determine risk factors for complications in patients undergoing open reduction internal fixation (ORIF) for distal radius fractures. METHODS The American College of Surgeons National Surgical Quality Improvement Program database for the 2006-2012 years was queried to identify all patients who underwent an ORIF of a distal radius fracture based on Current Procedural Terminology codes 25607, 25608, or 25609. The database is a statistically representative sample of prospectively collected perioperative surgical data from hospitals primarily in the United States. Demographics, comorbidities, preoperative laboratory values, and 30-day complications were compared between the patient groups with and without a postoperative complication. Multivariate analysis was performed to identify patient characteristics and comorbidities that were independently associated with early postoperative complications. RESULTS This retrospective analysis identified 3,003 patients who underwent an ORIF of the distal radius over 7 years. The number of patients with a complication within 30 days after surgery was 62 (2%), totaling 90 complications. Incidence of return to the operative room for the entire study population was 1.1%. Multivariate analysis, adjusting for confounding variables, showed that patients with a complication were more likely to have hypertension, congestive heart failure, preoperative chemotherapy or radiotherapy, longer operating time, and manifest preoperative impairment in independent living. CONCLUSIONS Approximately 2% of patients sustained a complication within 30 days following ORIF of a distal radius fracture. Recognition of the risk factors may help avoid complications in the identified high-risk patients. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.

Comparison of perioperative complications after total elbow arthroplasty in patients with and without diabetes

Background: The aim of this investigation was to analyze a nationally representative admissions database to evaluate the effect of diabetes mellitus on the rate of perioperative complications and hospitalization outcomes after ankle arthrodesis (AAD) and total ankle arthroplasty (TAA). Methods: Using the Nationwide Inpatient Sample database, 12 122 patients who underwent AAD and 2973 patients who underwent TAA were identified from 2002 to 2011 based on ICD-9 procedure codes. The perioperative complications and hospitalization outcomes were compared between diabetic and nondiabetic patients for each surgery during the index hospital stay. Results: The overall complication rate in the AAD group was 16.4% in diabetic patients and 7.0% in nondiabetic patients (P < .001). Multivariate analysis demonstrated that diabetes mellitus was independently associated with an increased risk of myocardial infarction (relative risk [RR] = 3.2, P = .008), urinary tract infection (RR = 4.6, P < .001), blood transfusion (RR = 3.0, P < .001), irrigation and debridement (RR = 1.9, P = .001), and overall complication rate (RR = 2.7, P < .001). Diabetes was also independently associated with a statistically significant increase in length of hospital stay (difference = 0.35 days, P < .001), more frequent nonhome discharge (RR = 1.69, P < .001), and higher hospitalization charges (difference =

Failure of the lesser tuberosity osteotomy after total shoulder arthroplasty

1908, P = .04). The overall complication rate in the TAA group was 7.8% in diabetic patients and 4.7% in nondiabetic patients. Multivariate analysis demonstrated that diabetes was independently associated with increased risk of blood transfusion (RR = 9.8, P = .03) and overall complication rate (RR = 4.1, P = .02). Diabetes was also independently associated with a statistically significant increase in length of stay (difference = 0.41 days, P < .001) and more frequent nonhome discharge (RR = 1.88, P < .001), but there was no significant difference in hospitalization charges (P = .64). Conclusion: After both AAD and TAA, diabetes mellitus was independently associated with a significantly increased risk of perioperative complications, nonhome discharge, and length of hospital stay during the index hospitalization. Level of Evidence: Level III, comparative series.

Thromboembolic Disease in Patients with Metastatic Femoral Lesions: A Comparison Between Prophylactic Fixation and Fracture Fixation

BACKGROUND Few studies have analyzed the effect of diabetes on outcomes after total elbow arthroplasty (TEA). We investigated the perioperative complications after TEA in patients with and without diabetes. METHODS We evaluated the Nationwide Inpatient Sample (NIS) database from 2005 to 2010 for patients who underwent a TEA. Our retrospective study included 3184 patients based on International Classification of Diseases-Ninth Revision, Clinical Modification codes. We compared outcomes in 488 patients with diabetes and in 2696 patients without diabetes. RESULTS Patients with diabetes had a significantly older mean age (66.8 vs 58.5 years, P < .001). There was no statistically significant difference when comparing length of stay (4.1 vs 3.7 days, P = .056) and cost of surgery (

Primary meningococcal arthritis requiring surgical drainage.

56,582 vs

Septic Arthritis of the Shoulder: A Comparison of Treatment Methods

56,092, P = .833). A significantly higher percentage of diabetic patients underwent TEA for the indication of fracture (73.4% vs 65.3%), but a lower percentage for rheumatoid arthritis (10.2% vs 19.2%). They also had significantly increased rates of pneumonia (odds ratio [OR], 2.7), urinary tract infection (OR, 2.2), blood transfusion (OR, 2.1), and nonroutine discharge (OR, 1.9). After adjusting for significantly increased rates of comorbidities in diabetic patients, our multivariate analysis showed that having diabetes was independently associated with an increased risk of pneumonia (relative risk [RR], 2.6), urinary tract infection (RR, 1.9), and cerebrovascular accident (RR, 9.1). However, diabetes was not independently associated with hospital length of stay (P = .75), after correction, hospital cost (P = .63), or proportion of routine discharges (P = .12). CONCLUSION Patients with diabetes have higher rates of comorbidities and perioperative complications after TEA.