Shobhit V. Minhas

The NFL Orthopaedic Surgery Outcomes Database (NO-SOD) The Effect of Common Orthopaedic Procedures on Football Careers

Background: Injuries are inherent to the sport of American football and often require operative management. Outcomes have been reported for certain surgical procedures in professional athletes in the National Football League (NFL), but there is little information comparing the career effect of these procedures. Purpose: To catalog the postoperative outcomes of orthopaedic procedures in NFL athletes and to compare respective prognoses and effects on careers. Study Design: Case series; Level of evidence, 4. Methods: Athletes in the NFL undergoing procedures for anterior cruciate ligament (ACL) tears, Achilles tendon tears, patellar tendon tears, cervical disc herniation, lumbar disc herniation, sports hernia, knee articular cartilage repair (microfracture technique), forearm fractures, tibial shaft fractures, and ankle fractures were identified through team injury reports or other public records. Game and performance statistics during the regular season were collected before and after surgery. Statistical analysis was performed with significance accepted as P < .05. Results: A total of 559 NFL athletes were included. Overall, 79.4% of NFL athletes returned to play after an orthopaedic procedure. Forearm open reduction and internal fixation (ORIF), sports hernia repair, and tibia intramedullary nailing (IMN) led to significantly higher return-to-play (RTP) rates (90.2%-96.3%), while patellar tendon repair led to a significantly lower rate (50%) (P < .001). Athletes undergoing ACL reconstruction (ACLR), Achilles tendon repair, patellar tendon repair, and ankle fracture ORIF had significant declines in games played at 1 year and recovered to baseline at 2 to 3 years after surgery. Athletes undergoing ACLR, Achilles tendon repair, patellar tendon repair, and tibia IMN had decreased performance in postoperative season 1. Athletes in the Achilles tendon repair and tibia IMN cohorts recovered to baseline performance, while those in the ACLR and patellar tendon repair cohorts demonstrated sustained decreases in performance. Conclusion: ACLR, Achilles tendon repair, and patellar tendon repair have the greatest effect on NFL careers, with patellar tendon repair faring worst with respect to the RTP rate, career length after surgery, games played, and performance at 1 year and 2 to 3 years after surgery.

Administrative databases in orthopaedic research: Pearls and pitfalls of big data

The drive for evidence-based decision-making has highlighted the shortcomings of traditional orthopaedic literature. Although high-quality, prospective, randomized studies in surgery are the benchmark in orthopaedic literature, they are often limited by size, scope, cost, time, and ethical concerns and may not be generalizable to larger populations. Given these restrictions, there is a growing trend toward the use of large administrative databases to investigate orthopaedic outcomes. These datasets afford the opportunity to identify a large numbers of patients across a broad spectrum of comorbidities, providing information regarding disparities in care and outcomes, preoperative risk stratification parameters for perioperative morbidity and mortality, and national epidemiologic rates and trends. Although there is power in these databases in terms of their impact, potential problems include administrative data that are at risk of clerical inaccuracies, recording bias secondary to financial incentives, temporal changes in billing codes, a lack of numerous clinically relevant variables and orthopaedic-specific outcomes, and the absolute requirement of an experienced epidemiologist and/or statistician when evaluating results and controlling for confounders. Despite these drawbacks, administrative database studies are fundamental and powerful tools in assessing outcomes on a national scale and will likely be of substantial assistance in the future of orthopaedic research.

The Effect of an Orthopaedic Surgical Procedure in the National Basketball Association

Background: Professional basketball players have a high incidence of injuries requiring surgical intervention. However, no studies in the current literature have compared postoperative performance outcomes among common injuries to determine high- and low-risk procedures to these athletes’ careers. Purpose: To compare return-to-play (RTP) rates and performance-based outcomes after different orthopaedic procedures in National Basketball Association (NBA) players and to determine which surgeries are associated with the worst postoperative change in performance. Study Design: Cohort study; Level of evidence, 3. Methods: Athletes in the NBA undergoing anterior cruciate ligament reconstruction, Achilles tendon repair, lumbar discectomy, microfracture, meniscus surgery, hand/wrist or foot fracture fixation, and shoulder stabilization were identified through team injury reports and archives on public record. The RTP rate, games played per season, and player efficiency rating (PER) were determined before and after surgery. Statistical analysis was used to compare the change between pre- and postsurgical performance among the different injuries. Results: A total of 348 players were included. The RTP rates were highest in patients with hand/wrist fractures (98.1%; mean age, 27.0 years) and lowest for those with Achilles tears (70.8%; mean age, 28.4 years) (P = .005). Age ≥30 years (odds ratio [OR], 3.85; 95% CI, 1.24-11.91) and body mass index ≥27 kg/m2 (OR, 3.46; 95% CI, 1.05-11.40) were predictors of not returning to play. Players undergoing Achilles tendon repair and arthroscopic knee surgery had a significantly greater decline in postoperative performance outcomes at the 1- and 3-year time points and had shorter career lengths compared with the other procedures. Conclusion: NBA players undergoing Achilles tendon rupture repair or arthroscopic knee surgery had significantly worse performance postoperatively compared with other orthopaedic procedures.

Preoperative predictors of increased hospital costs in elective anterior cervical fusions: a single-institution analysis of 1,082 patients

BACKGROUND CONTEXT The frequency of anterior cervical fusion (ACF) surgery and total hospital costs in spine surgery have substantially increased in the last several years. PURPOSE To determine which patient comorbidities are associated with increased total hospital costs after elective one- or two-level ACFs. STUDY DESIGN/SETTING Retrospective cohort analysis. PATIENT SAMPLE Individuals who have undergone elective one- or two-level ACFs at our single institution. The total number of patients amounted to 1,082. OUTCOME MEASURES Total hospital costs during single admission. METHODS Multivariate linear regression models were used to analyze independent effects of preoperative patient characteristics on total hospital costs. Univariate analysis was used to examine association of these characteristics on operative time, length of hospital stay (LOS), and complications. RESULTS Age, obesity, and diabetes were independently associated with increased average hospital costs of

A Predictive Risk Index for 30-day Readmissions Following Surgical Treatment of Pediatric Scoliosis.

1,404 (95% confidence interval [CI],

Surgeon specialty differences in single-level anterior cervical discectomy and fusion.

857-

Nationwide 30-Day Readmissions After Elective Orthopedic Surgery: Reasons and Implications.

1,951; p<.001),

Outcomes After Lumbar Disc Herniation in the National Basketball Association

681 (95% CI,

Assessing the Rates, Predictors, and Complications of Blood Transfusion Volume in Posterior Arthrodesis for Adolescent Idiopathic Scoliosis

285-

A comparison of 30-day complications following plate fixation versus intramedullary nailing of closed extra-articular tibia fractures.

1,076; p=.001), and