Taylor D. Ottesen

Revision Total Knee Arthroplasty in Octogenarians: An Analysis of 957 Cases

BACKGROUNDnThe number of octogenarians undergoing revision total knee arthroplasty (TKA) is increasing. However, there has been a lack of studies investigating the perioperative course and safety of revision TKA performed in this potentially vulnerable population in a large patient population. The purpose of this study is to compare complications following revision TKA between octogenarians and 2 younger patient populations (<70 and 70-79 year olds).nnnMETHODSnPatients who underwent revision TKA were identified in the 2005-2015 National Surgical Quality Improvement Program database and stratified into 3 age groups: <70, 70-79, and ≥80 years. Baseline preoperative and intraoperative characteristics were compared between the 3 groups. Propensity score matched comparisons were then performed for 30-day perioperative complications, length of hospital stay, and readmissions.nnnRESULTSnThis study included 6523 (<70 years), 2509 (70-79 years), and 957 octogenarian patients who underwent revision TKA. After propensity matching, statistical analysis revealed only higher rates of blood transfusion and slightly longer length of stay in octogenarians compared to <70 year olds. Similarly, octogenarians had only higher rates of blood transfusion and slightly longer length of stay compared to 70-79 year olds. Notably, there were no differences in mortality or readmission between octogenarians compared to younger populations.nnnCONCLUSIONnThese data suggest that revision TKA can safely be considered for octogenarians with the observation of higher rates of blood transfusion and slightly longer length of stay compared to younger populations. Octogenarian patients need not be discouraged from revision TKA solely based on their advanced age.

Choice of Quality Metrics for Assessment of the Spine Patient

Quality metrics are the methods by which hospitals and insurers measure the quality of care at a particular institution or practice. Examples of quality metrics include structural measures, process measures, objectively assessed outcome measures, registries, patient-reported outcome measures, and patient-reported satisfaction through the hospital consumer assessment of healthcare providers and systems. Each metric provides unique insight about the care a particular institution can provide. These metrics are particularly relevant in spine care with spinal issues being such a common reason for patients to seek medical attention and mixed surgical outcomes for different surgical indications. The results are useful to patients choosing the institution at which they receive treatment, to hospitals in guiding efforts to improve their quality of care, and to insurers to rate hospitals and providers to direct policies and reimbursements. These metrics are continually evolving in order to adapt to constantly changing healthcare systems. No single metric is perfect, while each have their own unique benefits and insights about an institution; they also come with some potential downsides that must be balanced by using a varied set of measures.

Evaluating the effect of growing patient numbers and changing data elements in the National Surgical Quality Improvement Program (NSQIP) database over the years: a study of posterior lumbar fusion outcomes

BACKGROUND CONTEXTnThe use of national databases in spinal surgery outcomes research is increasing. A number of variables collected by the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) changed between 2010 and 2011, coinciding with a rapid increase in the number of patients included per year. However, there has been limited study evaluating the effect that these changes may have on the results of outcomes studies.nnnPURPOSEnThe present study aimed to investigate the influence of changing data elements and growth of the NSQIP database on results of lumbar fusion outcomes studies.nnnSTUDY DESIGN/SETTINGnThis is a retrospective cohort study of prospectively collected data.nnnPATIENT SAMPLEnThe NSQIP database was retrospectively queried to identify 19,755 patients who underwent elective posterior lumbar fusion surgery with or without interbody fusion between 2005 and 2014. Patients were split into two groups based on year of surgery: 2,802 from 2005 to 2010 and 16,953 from 2011 to 2014.nnnOUTCOME MEASURESnThe occurrence of adverse events after discharge from the hospital, within postoperative day 30, was determined.nnnMETHODSnPreoperative characteristics and 30-day perioperative outcomes were compared between the era groups using bivariate analysis. To illustrate the effect of such changing data elements, the association between age and postoperative outcomes in the era groups was analyzed using multivariate Poisson regression. The present study had no funding sources, and there were no study-related conflicts of interest for any authors.nnnRESULTSnThere were significant differences between the era groups for a variety of preoperative characteristics. Postoperative events such blood transfusion and deep vein thrombosis were also significantly different between the era groups. For the 2005-2010 cohort, age was significantly associated with septic shock by multivariate analysis. For the 2011-2014 cohort, age was significantly associated with septic shock, urinary tract infection, blood transfusion, myocardial infarction, and extended length of stay.nnnCONCLUSIONSnThe NSQIP database has undergone substantial changes between 2005 and 2014. These changes may contribute to different results in analyses, such as the association between age and postoperative outcomes, when using older versus newer data. Conclusions from early studies using this database may warrant reconsideration.

Dialysis is an independent risk factor for perioperative adverse events, readmission, reoperation, and mortality for patients undergoing elective spine surgery

BACKGROUND CONTEXTnThe prevalence of dialysis-dependent patients in the United States is growing. Prior studies evaluating the risk of perioperative adverse events for dialysis-dependent patients are either institutional cohort studies limited by patient numbers or administrative database studies limited to inpatient data.nnnPURPOSEnThe present study uses a large, national sample with 30-day follow-up to investigate dialysis as risk factor for perioperative complications independent of patient demographics or comorbidities.nnnSTUDY DESIGN/SETTINGnThis is a retrospective cohort study.nnnPATIENT SAMPLEnPatients undergoing elective spine surgery with or without dialysis from the 2005-2015 National Surgical Quality Improvement Program (NSQIP) database were included in the study.nnnOUTCOME MEASURESnPostoperative complications within 30 days and binomial reoperation, readmission, and mortality within 30 days were determined.nnnMETHODSnThe 2005-2015 NSQIP databases were queried for adult dialysis-dependent and dialysis-independent patients undergoing elective spinal surgery. Differences in 30-day outcomes were compared using risk-adjusted multivariate regression and coarsened exact matching analysis for adverse events, unplanned readmission, reoperation, and mortality. The percentage of complications occurring before versus after hospital discharge was also assessed. The authors have no financial disclosures related to the present study.nnnRESULTSnA total of 467 dialysis and 173,311 non-dialysis patients met the inclusion criteria. Controlling for age, gender, body mass index, functional status, and American Society of Anesthesiologists (ASA) class, dialysis patients were found to be at significantly greater odds of any adverse event (odds ratio [OR]=2.52 before, 2.17 after matching, p=<.001), major adverse event (OR=2.90 before, 2.52 after matching, p=<.001), and minor adverse event (OR=1.50 before matching, p=<.025, but not significantly different after matching). Further, dialysis patients were significantly more likely to return to the operating room (OR=2.77 before, 2.50 after matching, p=<.001), have unplanned readmissions (OR=2.73 before, 2.37 after matching, p=<.001), and die within 30 days (OR=3.77 before, 2.71 after matching, p=<.001). Adverse events occurred after discharge for 51.78% of non-dialysis patients and for 43.80% of dialysis patients.nnnCONCLUSIONSnDialysis patients undergoing elective spine surgery are at significantly higher risk of aggregated adverse outcomes, return to the operating room, readmission, and death than non-dialysis patients, even after controlling for patient demographics and overall health (as indicated by ASA class). These differences need to be considered when determining treatment options. Additionally, with bundled payments expected in spine surgery, physicians and hospitals need to account for increased costs and liabilities when working with dialysis patients.

Acute and Chronic Musculoskeletal Injury in Para Sport: A Critical Review

Sport-related injury patterns among Para athletes have been described with increasing frequency. This review summarizes musculoskeletal injuries in Para athletes. Seated Para athletes sustain upper extremity injuries more commonly; ambulant Para athletes frequently sustain lower extremity injuries. The upper extremity is the most commonly injured anatomic area in all Para athletes, unlike able-bodied athletes. Advanced age and spinal cord injury may increase the risk of upper extremity injury. Injury data for recreational and youth Para athletes are sparse. Summarizing current injury epidemiology data may help to accelerate the development of injury prevention strategies and lifetime injury models for Para athletes.

The Cost of Complications Following Major Resection of Malignant Neoplasia

BackgroundRising healthcare costs have led to increased focus on the need to achieve a higher “value of care.” As value-maximization efforts expand to include more complex surgical patients, evidence to support meaningful implementation of complication-based initiatives is lacking. The objective of this study was to compare incremental costs of complications following major gastrointestinal (GI) resections for organ-specific malignant neoplasia using nationally representative data.MethodsNational (Nationwide) Inpatient Sample data, 2001–2014, were queried for adult (≥u200918xa0years) patients undergoing major resections for malignant neoplasia. Based on system-based complications considered relevant to the long-term treatment of GI disease, stratified differences in risk-adjusted incremental hospital costs and complication probabilities were compared. Differences in surgical outcomes and costs over time were also assessed.ResultsA total of 293,967 patients were included, weighted to represent 1,408,117 patients nationwide. One fourth (26.1%; 95% CI, 25.7–26.4%) experienced ≥u20091 pre-discharge complication (range, 45.3% esophagectomy to 24.0% rectal resection). Resultant annual risk-adjusted incremental hospital costs totaled

Aseptic revision total hip arthroplasty in the elderly : quantifying the risks for patients over 80 years old.

540 million nationwide (19.5% of the overall cost of care and an average of

Dialysis Patients Undergoing Total Knee Arthroplasty Have Significantly Increased Odds of Perioperative Adverse Events Independent of Demographic and Comorbidity Factors

20,900 per patient). Costs varied substantially with both cancer/resection type and complication group, ranging from

The Rothman Index Is Associated With Postdischarge Adverse Events After Hip Fracture Surgery in Geriatric Patients

76.7 million for colectomies with infectious complications to

Risk factors and pharmacologic prophylaxis for venous thromboembolism in elective spine surgery

0.2 million for rectal resections with urinary complications. For each resection type, infectious (