Orthopedics最新文献

{"title":"Prolonged Opioid Use and Associated Factors After Open Reduction and Internal Fixation of Tibial Shaft Fractures.","authors":"Zakaria Chakrani, Carolina Stocchi, Husni Alasadi, Nicole Zubizarreta, Brocha Z Stern, Jashvant Poeran, David A Forsh","doi":"10.3928/01477447-20240605-02","DOIUrl":"10.3928/01477447-20240605-02","url":null,"abstract":"<p><strong>Background: </strong>The aim of this retrospective cohort study was to determine the rate of prolonged opioid use and identify associated risk factors after perioperative opioid exposure for tibial shaft fracture surgery.</p><p><strong>Materials and methods: </strong>We used the MarketScan Commercial Claims and Encounters database (IBM) to identify patients 18 to 64 years old who filled a peri-operative opioid prescription after open reduction and internal fixation of a tibial shaft fracture from January 2016 to June 2020. Multivariable logistic regression identified factors (eg, demographics, comorbidities, medications) associated with prolonged opioid use (ie, filling an opioid prescription 91 to 180 days postoperatively); adjusted odds ratios (ORs) and 95% CIs were reported.</p><p><strong>Results: </strong>The rate of prolonged opioid use was 10.5% (n=259/2475) in the full cohort and 6.1% (n=119/1958) in an opioid-naive subgroup. In the full cohort, factors significantly associated with increased odds of prolonged use included preoperative opioid use (OR, 4.76; 95% CI, 3.60-6.29; <i>P</i><.001); perioperative oral morphine equivalents in the 4th (vs 1st) quartile (OR, 2.68; 95% CI, 1.75-4.09; <i>P</i><.001); age (OR, 1.03; 95% CI, 1.02-1.04; <i>P</i><.001); and alcohol or substance-related disorder (OR, 1.66; 95% CI, 1.15-2.40; <i>P</i>=.01). Patients in the Northeast and North Central (vs South) regions had decreased odds of prolonged use (OR, 0.61-0.69; <i>P</i>=.02-.04). When removing preoperative use, findings were similar in the opioid-naive subgroup.</p><p><strong>Conclusion: </strong>Prolonged opioid use is not uncommon in this orthopedic trauma population, with the strongest risk factor being preoperative opioid use. Nevertheless, shared risk factors exist between the opioid-naive and opioid-tolerant subgroups that can guide clinical decision-making. [<i>Orthopedics</i>. 2024;47(4):e188-e196.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e188-e196"},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141306522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Site of Service Disparities Exist for Total Joint Arthroplasty.","authors":"Nicole M Truong, Chelsea V Leversedge, Thompson Zhuang, Lauren M Shapiro, Mathew J Whittaker, Robin N Kamal","doi":"10.3928/01477447-20240304-01","DOIUrl":"10.3928/01477447-20240304-01","url":null,"abstract":"<p><strong>Background: </strong>The rate of outpatient total joint arthroplasty procedures, including those performed at ambulatory surgical centers (ASCs) and hospital outpatient departments, is increasing. The purpose of this study was to analyze if type of insurance is associated with site of service (in-patient vs outpatient) for total joint arthroplasty and adverse outcomes.</p><p><strong>Materials and methods: </strong>We identified patients undergoing unicompartmental knee arthroplasty (UKA), total knee arthroplasty (TKA), or total hip arthroplasty (THA) using <i>Current Procedural Terminology</i> codes in a national administrative claims database. Eligible patients were stratified by type of insurance (Medicaid, Medicare, private). The primary outcome was site of service. Secondary outcomes included general complications, procedural complications, and revision procedures. We evaluated the associations using adjusted multivariable logistic regression models.</p><p><strong>Results: </strong>We identified 951,568 patients for analysis; 46,703 (4.9%) patients underwent UKA, 607,221 (63.8%) underwent TKA, and 297,644 (31.3%) underwent THA. Overall, 9.6% of procedures were outpatient. Patients with Medicaid were less likely than privately insured patients to receive outpatient UKA or THA (UKA: odds ratio [OR], 0.729 [95% CI, 0.640-0.829]; THA: OR, 0.625 [95% CI, 0.557-0.702]) but more likely than patients with Medicare to receive outpatient TKA or THA (TKA: OR, 1.391 [95% CI, 1.315-1.472]; THA: OR, 1.327 [95% CI, 1.166-1.506]). Patients with Medicaid were more likely to experience complications and revision procedures.</p><p><strong>Conclusion: </strong>Differences in site of service and complication rates following hip and knee arthroplasty exist based on type of insurance, suggesting a disparity in care. Further exploration of drivers of this disparity is warranted and can inform interventions (eg, progressive value-based payments) to support equity in orthopedic services. [<i>Orthopedics</i>. 2024;47(3):179-184.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"179-184"},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140102091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased 90-Day Mortality and Morbidity Among Patients Recovering From Elective Primary Arthroplasty During the COVID-19 Pandemic in New York City.","authors":"Megan M Mizera, Zeynep Seref-Ferlengez, Anna Tarasova, Evan Mostafa, Eli Kamara, Sun Jin Kim","doi":"10.3928/01477447-20231027-05","DOIUrl":"10.3928/01477447-20231027-05","url":null,"abstract":"<p><p>All elective procedures were stopped in March 2020 because of the coronavirus disease 2019 (COVID-19) pandemic. We report the 90-day mortality and complications of patients who underwent primary arthroplasty before the stopping of elective procedures at a single academic medical center. A retrospective cohort study was conducted including patients who underwent elective primary arthroplasty between December 2019 and mid-March 2020. Their 90-day postoperative mortality and medical complications were statistically compared with those of a historical cohort from the same operative period in 2019. The 2020 and 2019 cohorts included 372 and 410 patients, respectively. Except for the prevalence of diabetes, there was no significant difference between the two cohorts regarding baseline characteristics or preoperative health. The 2020 cohort had statistically significant higher rates of pneumonia (2.7% vs 0.7%; <i>P</i>=.03), readmission (9.1% vs 5.4%; <i>P</i>=.04), pulmonary embolism (1.6% vs 0.2%; <i>P</i>=.04), and 90-day mortality (1.1% vs 0%; <i>P</i>=.04). The 2020 cohort also had a trend for increased rates of deep venous thrombosis (1.1% vs 0.7%; <i>P</i>=.7) and cardiac complications (1.9% vs 0.5%; <i>P</i>=.07) and no change in emergency department visits (14.0% vs 11.7%; <i>P</i>=.3). There were 7 confirmed cases of COVID-19 in the 2020 cohort and 1 death. This study demonstrates that patients who underwent primary arthroplasty procedures at our institution close to the time of the first wave of the COVID-19 pandemic experienced a statistically significant increase in mortality, pneumonia, pulmonary embolism, and readmission compared with a historical cohort. As elective procedures have resumed during the ongoing pandemic, providers and patients should be aware of these increased risks. [<i>Orthopedics</i>. 2024;47(3):135-140.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"135-140"},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71425733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nearly All Peer-to-Peer Reviews for CT and MRI Prior Authorization Denials for Orthopedic Specialists Are Approved.","authors":"Nareena Imam, Jay M Zaifman, Rocco Bassora, Chris Cherian, Eitan M Kohan, Frank G Alberta, John D Koerner","doi":"10.3928/01477447-20231027-08","DOIUrl":"10.3928/01477447-20231027-08","url":null,"abstract":"<p><p>In the event of prior authorization denial, physicians may request peer-to-peer review, which may delay treatment and increase administrative burden. The purpose of this study was to quantify the approval rate of peer-to-peer review and evaluate its efficiency in the context of advanced imaging use in an orthopedic practice. Patients at a single outpatient orthopedic clinic initially receiving an insurance denial for computed tomography or magnetic resonance imaging requiring peer-to-peer review from March to December 2022 were prospectively enrolled. Characteristics of the request, peer-to-peer review, and the reviewer and dates in the process were collected. If the study was approved after peer-to-peer review, the date of the imaging study and brief results were recorded. A total of 62 denials were included. One denial was approved prior to peer-to-peer review. Fifty-eight (of 61, 95.1%) reviews were approved, of which 51 (of 58, 87.9%) studies were completed by patients. Reviewers were always physicians (61 of 61, 100%), but of those whose specialty was known, none were orthopedic surgeons. Forty-four of 61 (72.1%) reviewers reported reviewing clinical notes in advance. The median number of days from visit to peer-to-peer review was 9.0 (interquartile range, 7.0-13.25). The median number of days from visit to imaging center appointment was 13.5 (interquartile range, 9.0-20.75) for approved studies. Of the 51 approved studies completed by patients, the results of 38 (74.5%) confirmed the suspected diagnosis. In an orthopedic specialty practice, almost all peer-to-peer reviews were approved, with the majority of the completed studies confirming the suspected diagnosis. Thus, patient care was delayed. Reform is crucial to improve the efficiency of the review process, especially in light of additional administrative and financial burden. [<i>Orthopedics</i>. 2024;47(3):141-146.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"141-146"},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71425734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Postoperative Change in Hip Rotation Angle and Factors Contributing to It for Patients Undergoing Total Hip Arthroplasty.","authors":"Toshiyuki Tateiwa, Toshinori Masaoka, Yasuhito Takahashi, Tsunehito Ishida, Takaaki Shishido, Kengo Yamamoto","doi":"10.3928/01477447-20231220-01","DOIUrl":"10.3928/01477447-20231220-01","url":null,"abstract":"<p><strong>Objective: </strong>A possible impairment in hip proprioception after total hip arthroplasty (THA) has been an issue of concern. The aims of this study were to investigate the extent of early postoperative change in standing hip rotation angle (HRAng) in patients with osteoarthritis (OA) undergoing THA and to consider a possible mechanism behind this.</p><p><strong>Materials and methods: </strong>A total of 82 hips (82 patients; 63 women and 19 men) undergoing unilateral primary THA with total capsulectomy were included. We characterized the standing HRAng and internal/external range of motion (ROM) in the prone position before THA and 2 weeks after THA. Acetabular/cup and femoral/stem anteversion, combined anteversion (CA), and leg length discrepancy were also characterized. Correlations were examined postoperatively between the HRAng and the other analyzed variables.</p><p><strong>Results: </strong>The median standing HRAng showed a significant internal shift from external to more medial position (6.3° to 1.7°) 2 weeks after THA (<i>P</i><.0001). The postoperative change in standing HRAng was significantly negatively correlated with the difference between the postoperative femoral anteversion and the stem anteversion (<i>r</i>_s=-0.429, <i>P</i><.0001) and with the pre- to postoperative change in CA (<i>r</i>_s=-0.3012, <i>P</i>=.0063).</p><p><strong>Conclusion: </strong>This study demonstrated that the extent of the rotational shift of the distal femur toward medial direction was significantly associated with increasing stem anteversion and CA. This phenomenon can be interpreted as a compensatory mechanism for maintaining the relative positional relationship between the pelvis and the proximal femur using proprioception. Therefore, we conclude that the extracapsular/extra-articular components may be prominent determinants of joint position sense. [<i>Orthopedics</i>. 2024;47(3):e114-e118.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e114-e118"},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139040335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishment of a Rabbit Model of Adjacent Intervertebral Disk Degeneration After Lumbar Fusion and Fixation and Evaluation of Autophagy Factor Expression in Nucleus Pulposus Cells","authors":"Jiawen Sun, MMed, Fuyu Chen, MMed, Xiaodong Wei, MMed, Yufu Ou, MD","doi":"10.3928/01477447-20240424-04","DOIUrl":"https://doi.org/10.3928/01477447-20240424-04","url":null,"abstract":"<section><h3>Background:</h3><p>The objectives of this research were to establish an animal model of adjacent segment degeneration (ASD) bordering lumbar fusion and to investigate the expression of autophagy factors in nucleus pulposus cells of adjacent intervertebral disks.</p></section><section><h3>Materials and Methods:</h3><p>Twenty-four adult New Zealand white rabbits were enrolled and divided into two groups: group A (n=12) and group B (n=12). Posterolateral fusion and fixation were performed after intervertebral disk degeneration occurred in group A, and the rabbits were monitored for 6 months. Group B was the control group and did not undergo fusion surgery. These rabbits were monitored for 6 months. Real-time quantitative polymerase chain reaction and immunohistochemistry were performed to detect the mRNA and protein expressions of PTEN-induced kinase 1 (PINK1), Parkin, ADAMTS-4, and MMP-3. An external database, the GEO database, was used to examine the expression of these genes and analyze them for differential expression.</p></section><section><h3>Results:</h3><p>After lumbar fusion in rabbits, the animal model of ASD exhibited gradual degeneration of adjacent intervertebral disks over time. Group A displayed significantly higher mRNA and protein expressions of PINK1 and MMP-3 but lower expression of ADAMTS-4 compared with group B (<i>P</i>&lt;.05). The results analyzed in the GEO database showed that the expression of PINK1 was higher in group A than in group B, while the expression of ADAMTS-4 was lower in group A than in group B.</p></section><section><h3>Conclusion:</h3><p>After posterolateral lumbar fusion in rabbits, the animal ASD model showed gradual deterioration of adjacent intervertebral disks with prolonged follow-up. The findings indicate the important role of autophagy in the apoptosis of nucleus pulposus cells in adjacent intervertebral disks. [<i>Orthopedics</i>. 202x;4x(x):xx–xx.]</p></section>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":"39 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140832313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Four-Year Outcomes of Cementless Versus Cemented Fixation of a Newly Introduced Total Knee Arthroplasty Design.","authors":"Timothy G Costales, David F Dalury","doi":"10.3928/01477447-20240122-02","DOIUrl":"10.3928/01477447-20240122-02","url":null,"abstract":"<p><strong>Background: </strong>Aseptic loosening continues to be a major cause of failure of total knee arthroplasty (TKA). Although cemented fixation remains the gold standard, there is renewed interest in cementless fixation as a means of decreasing this risk via biologic fixation. The purpose of this study was to evaluate the clinical outcomes of cemented and cementless versions of a newly introduced TKA design at an average of 4 years postoperatively.</p><p><strong>Materials and methods: </strong>This was a retrospective case-control study of 100 primary TKAs comparing cementless vs cemented TKAs using the same cruciate-retaining implant design (ATTUNE Knee System; DePuy Synthes). Fifty patients undergoing cementless TKA with a mean age of 60.8 years (range, 48-71 years) and body mass index (BMI) of 31.6 kg/m² (range, 23.7-41.9 kg/m²) were matched to 50 patients undergoing primary cemented TKA with a mean age of 62.7 years (range, 51-73 years) and BMI of 30.1 kg/m² (range, 24.6-43.9 kg/m²). The mean follow-up was 4.2 years (range, 4.0-4.4 years) in the cementless group and 7.6 years (range, 7.5-7.7 years) in the cemented group. Complications, clinical outcomes using the Knee Society Score (KSS), and radiographic analyses were evaluated at final follow-up. Student's <i>t</i> tests were used for statistical analyses.</p><p><strong>Results: </strong>There was no statistical difference in age, BMI, and preoperative KSS between the two groups (<i>P</i>=.12, <i>P</i>=.15, and <i>P</i>=.55, respectively). There were no complications or reoperations in either cohort. There were no statistical differences in range of motion and total KSS at final follow-up between the two groups. Final total KSS had a mean of 91.1 for the cementless group and 93.7 for the cemented group. There was no radiographic evidence of component subsidence or loosening in either cohort.</p><p><strong>Conclusion: </strong>When compared with its cemented counterpart, the newly introduced cementless TKA design had similar excellent clinical improvements and radiologic results at an average of 4 years of follow-up. [<i>Orthopedics</i>. 2024;47(3):161-166.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"161-166"},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139576153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiligament Knee Reconstruction With Suture Tape Augmentation: Patient-Reported Outcomes at Minimum 2-Year Follow-up","authors":"Brian Panish, MD, Jonathan J. Lawson, MS, Seleem Elkadi, MD, Eliana Schaefer, MD, Gregory Perraut, MD, Evan H. Argintar, MD","doi":"10.3928/01477447-20240424-02","DOIUrl":"https://doi.org/10.3928/01477447-20240424-02","url":null,"abstract":"<section><h3>Background:</h3><p>Multiligament knee injury (MLKI) is a severe subclass of orthopedic injury and can result in significant functional impairment. Novel MLKI graft constructs such as suture augmentation aim to enhance graft strength and optimize knee stability. The purpose of this study was to present patient-reported outcome measurements of a cohort at a minimum follow-up of 2 years after multiligament knee reconstruction (MLKR) with suture augmentation.</p></section><section><h3>Materials and Methods:</h3><p>A retrospective chart review was performed to identify patients who underwent MLKR with suture augmentation. Demographic and injury-specific variables were gathered preoperatively and postoperatively. Patients were contacted at a minimum of 2 years postoperatively to collect Patient-Reported Outcomes Measurement Information System, Multiligament Quality of Life, and Lysholm knee scores.</p></section><section><h3>Results:</h3><p>Twenty-seven patients underwent MLKR with suture augmentation, with 15 being female (55.6%) and 12 being male (44.4%). The mean pain score was 49.93±9.96, the mean physical function score was 49.56±10.94, and the mean mobility score was 47.56±8.58. The mean physical impairment score was 33.96±23.69, the mean emotional impairment score was 36.55±26.60, the mean activity limitation score was 28.00±25.61, and the mean societal involvement score was 30.09±27.45. The mean Lysholm knee score for the cohort was 67.93±22.36.</p></section><section><h3>Conclusion:</h3><p>Patients who underwent MLKR with suture augmentation had satisfactory scores across all patient-reported outcome measurements. On the basis of these criteria, the average patient achieved an acceptable clinical outcome, demonstrating that MLKR with suture augmentation is a safe and efficacious surgical technique for the treatment of MLKI. [<i>Orthopedics</i>. 202x;4x(x):xx–xx.]</p></section>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140832341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of Two Artificial Intelligence Generative Language Models on the Orthopaedic In-Training Examination.","authors":"Marc Lubitz, Luke Latario","doi":"10.3928/01477447-20240304-02","DOIUrl":"10.3928/01477447-20240304-02","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) generative large language models are powerful and increasingly accessible tools with potential applications in health care education and training. The annual Orthopaedic In-Training Examination (OITE) is widely used to assess resident academic progress and preparation for the American Board of Orthopaedic Surgery Part 1 Examination.</p><p><strong>Materials and methods: </strong>Open AI's ChatGPT and Google's Bard generative language models were administered the 2022 OITE. Question stems that contained images were input without and then with a text-based description of the imaging findings.</p><p><strong>Results: </strong>ChatGPT answered 69.1% of questions correctly. When provided with text describing accompanying media, this increased to 77.8% correct. In contrast, Bard answered 49.8% of questions correctly. This increased to 58% correct when text describing imaging in question stems was provided (<i>P</i><.0001). ChatGPT was most accurate in questions within the shoulder category, with 90.9% correct. Bard performed best in the sports category, with 65.4% correct. ChatGPT performed above the published mean of Accreditation Council for Graduate Medical Education orthopedic resident test-takers (66%).</p><p><strong>Conclusion: </strong>There is significant variability in the accuracy of publicly available AI models on the OITE. AI generative language software may play numerous potential roles in the future in orthopedic education, including simulating patient presentations and clinical scenarios, customizing individual learning plans, and driving evidence-based case discussion. Further research and collaboration within the orthopedic community is required to safely adopt these tools and minimize risks associated with their use. [<i>Orthopedics</i>. 2024;47(3):e146-e150.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e146-e150"},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140102090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Inclusive Analysis of Racial and Ethnic Disparities in Orthopedic Surgery Outcomes.","authors":"Maveric K I L Abella, Tyler Thorne, Jeffrey Hayashi, Andrea K Finlay, Steven Frick, Derek F Amanatullah","doi":"10.3928/01477447-20240122-01","DOIUrl":"10.3928/01477447-20240122-01","url":null,"abstract":"<p><strong>Background: </strong>Despite increasing attention, disparities in outcomes for Black and Hispanic patients undergoing orthopedic surgery are widening. In other racial-ethnic minority groups, outcomes often go unreported. We sought to quantify disparities in surgical outcomes among Asian, American Indian or Alaskan Native, and Native Hawaiian or Pacific Islander patients across multiple orthopedic subspecialties.</p><p><strong>Materials and methods: </strong>The National Surgical Quality Improvement Program was queried to identify all surgical procedures performed by an orthopedic surgeon from 2014 to 2020. Multivariable logistic regression models were used to investigate the impact of race and ethnicity on 30-day medical complications, readmission, reoperation, and mortality, while adjusting for orthopedic subspecialty and patient characteristics.</p><p><strong>Results: </strong>Across 1,512,480 orthopedic procedures, all patients who were not White were less likely to have arthroplasty-related procedures (<i>P</i><.001), and Hispanic, Asian, and American Indian or Alaskan Native patients were more likely to have trauma-related procedures (<i>P</i><.001). American Indian or Alaskan Native (adjusted odds ratio [AOR], 1.005; 95% CI, 1.001-1.009; <i>P</i>=.011) and Native Hawaiian or Pacific Islander (AOR, 1.009; 95% CI, 1.005-1.014; <i>P</i><.001) patients had higher odds of major medical complications compared with White patients. American Indian or Alaskan Native patients had higher risk of reoperation (AOR, 1.005; 95% CI, 1.002-1.008; <i>P</i>=.002) and Native Hawaiian or Pacific Islander patients had higher odds of mortality (AOR, 1.003; 95% CI, 1.000-1.005; <i>P</i>=.019) compared with White patients.</p><p><strong>Conclusion: </strong>Disparities regarding surgical outcome and utilization rates persist across orthopedic surgery. American Indian or Alaskan Native and Native Hawaiian or Pacific Islander patients, who are under-represented in research, have lower rates of arthroplasty but higher odds of medical complication, reoperation, and mortality. This study highlights the importance of including these patients in orthopedic research to affect policy-related discussions. [<i>Orthopedics</i>. 2024;47(3):e131-e138.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e131-e138"},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139576088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}