HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery最新文献

{"title":"Preoperative Workup of Operative Hip Fracture Patients: A Survey","authors":"G. Esper, Utkarsh Anil, S. Cavaleri, David L. Furgiuele, J. Zaretsky, S. Konda, K. Egol","doi":"10.1177/15563316231158546","DOIUrl":"https://doi.org/10.1177/15563316231158546","url":null,"abstract":"Background: There may be disagreement among stakeholders on the need for preoperative cardiac screening for elderly hip fracture patients. Purpose: We sought to assess preoperative workup perceptions among physicians for hip fracture patients across specialties, specifically considering a patient’s cardiovascular risk. Methods: A case-based survey was distributed to 50 physicians in each of the 4 departments involved in preoperative patient care: orthopedic surgery (OS), anesthesiology (A), cardiology (C), and hospital medicine (HM). The survey asked about which clinical presentations required a cardiology consult, as well as about further preoperative imaging and laboratory work. Single score intraclass correlation coefficient (ICC) was used to compare agreement. Results: Of the 200 surveys sent out, 33 responses (16.5% response rate) were received. Between all specialties, there was 72% agreement about preoperative cardiology consult need (intraclass correlation coefficient [ICC] = 0.063 or poor) and 71% agreement about preoperative transthoracic echocardiogram (TTE) need (ICC = 0.188 or poor). Within each specialty (A, C, HM, OS) ICCs measuring agreement for the need for cardiology consult were 0.812 (good), 0.561 (moderate), 0.457 (poor), and 0.414 (poor), respectively, and for the need for preoperative TTE were 0.852 (good), 0.441 (poor), 0.848 (good), and 0.188 (poor), respectively. Common preoperative testing requested included complete blood count, basic metabolic panel in all cases, and electrocardiogram with troponins if perioperative acute coronary syndrome symptoms were present. Conclusion: This survey suggests that there may be varying levels of agreement within specialties and poor agreement between specialties on the need for cardiology consultation and preoperative imaging for hip fracture patients. This suggests the need for established, reliable preoperative workup protocols with input from different specialties to streamline preoperative care for patients before hip fracture surgery.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126498587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Did Payment Reform Lead to Patient Selection in Hip and Knee Arthroplasties? An Observational Study Using New York State Data","authors":"Sara N. Kiani, S. Maron, S. Rosenzweig, N. Zubizarreta, J. Poeran, C. Moucha","doi":"10.1177/15563316231155387","DOIUrl":"https://doi.org/10.1177/15563316231155387","url":null,"abstract":"Background: While the comprehensive care for joint replacement (CJR) bundled payment program for total joint replacement (TJR) emphasizes value, concerns persist regarding unintended consequences, primarily hospital selection of healthier, younger patients. Purpose: We sought to assess changes in patient characteristics and outcomes after CJR implementation in New York State. Methods: This retrospective cohort study included primary total hip and total knee arthroplasties from the New York Statewide Planning and Research Cooperative System (SPARCS) database. Procedures performed before (July 2014 to March 2016; n = 58,610) and after (April 2016 to December 2017; n = 78,728) CJR implementation were compared. Primary outcomes were patient characteristics: Deyo-Comorbidity Index and age. Secondary outcomes were increased hospitalization cost, discharge to institutional post-acute care, and prolonged length of stay. A difference-in-differences analysis estimated changes after CJR implementation, comparing CJR to non-CJR hospitals. Results: We found that CJR implementation (in 49 of 144 New York State hospitals) coincided with slightly older and more comorbid TJR recipients. The CJR program coincided with significantly reduced hospitalization cost and discharge to institutional post-acute care but not length of stay. Some CJR effects appear to have affected non-Medicare patients, as well. Conclusion: This retrospective analysis suggests that in New York State, the CJR bundled payment program did not result in hospitals selecting younger and healthier TJR recipients and coincided with decreased costs and fewer discharges to institutional postacute care.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115884100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are Grit and Self-Control Associated With Patient-Reported Outcomes Following Spine Surgery?","authors":"M. Dupont, Kasra Araghi, Daniel Shinn, S. Qureshi, S. Iyer","doi":"10.1177/15563316221147193","DOIUrl":"https://doi.org/10.1177/15563316221147193","url":null,"abstract":"Background: Grit, defined as perseverance and passion for long-term goals, and self-control, defined as the capacity to regulate impulses in the presence of momentarily gratifying temptations or diversion, have shown to be predictors of professional achievement. Their role in health care outcomes is less well understood. Purpose: We sought to determine whether grit and self-control are associated with patient-reported outcome measures (PROMs) following spine surgery. Methods: We conducted a retrospective review of adult patients who underwent cervical or lumbar procedures by a single fellowship-trained spine surgeon between March 2017 and October 2020. We included patients who underwent anterior cervical discectomy and fusion, cervical disk replacement, minimally invasive laminectomy/laminoplasty (MI-D), or minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) with minimum 1-year follow-up. Grit and self-control scores were collected 1 year after the surgery. PROMs were collected preoperatively and at 6 postoperative timepoints. Grit and self-control were compared between patients who achieved substantial clinical benefit (SCB) in either physical or mental health versus those who did not. The association between grit/self-control and change in PROMs was also assessed. Results: In the 129 patients included in the analysis, we found that patients who achieved SCB in mental health had significantly higher grit scores than those who did not. In bivariate analysis, self-control was associated with greater improvement in leg pain scores at 1-year and 2-year follow-up following an MI-D. For the MI-TLIF cohort, grit was associated with a smaller change in Short Form 12 mental component score at 6 weeks, and self-control was associated with a smaller change in Patient-Reported Outcome Measurement Information System Physical Function at the 6-month timepoint. Grit and self-control were not associated with PROMs at other timepoints. Conclusion: This retrospective review found that grit and self-control were not significantly associated with PROMs at most postoperative timepoints in patients who underwent spine surgery.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132632942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Cannabis Use Did Not Increase Opioid Utilization After Primary Total Knee Arthroplasty in a Propensity Score–Matched Model","authors":"Simar Puri, Christian B. Ong, Yu-fen Chiu, Juliana Lebowitz, A. Sideris, A. Gonzalez Della Valle, B. Chalmers","doi":"10.1177/15563316221151158","DOIUrl":"https://doi.org/10.1177/15563316221151158","url":null,"abstract":"Background: Recreational and medicinal cannabis use is becoming increasingly popular, but there are little data on its effect on postoperative pain and opioid consumption after primary total knee arthroplasty (TKA). Purpose: We sought to evaluate the relationship between self-reported preoperative cannabis use and postoperative opioid consumption and post-discharge opioid prescriptions following elective primary TKA. Methods: We identified all patients who underwent unilateral, primary TKA for a diagnosis of osteoarthritis at a single institution between February 1, 2019, and April 30, 2021, and subdivided them into current cannabis users and non-users based on self-reported data. Regular users were propensity score-matched 1:6 with non-users using logistic regression on age, sex, body mass index (BMI), history of chronic pain, smoking status, history of anxiety/depression, American Society of Anesthesiology (ASA) classification, and type of anesthesia. Outcomes of interest included median inpatient (total, daily, and hourly) morphine milligram equivalents (MMEs), discharge MMEs, and outpatient MMEs within 90 days after surgery. Results: A cohort of 70 current cannabis users was matched with 420 non-users. There were no significant differences in opioid use in inpatient MMEs (hourly, daily, or total), discharge MMEs, or outpatient MMEs between cohorts. Also, there was no significant difference in hospital stay between cohorts. Conclusion: In this retrospective propensity score–matched model, preoperative cannabis use did not independently increase opioid use post-TKA in the inpatient or outpatient setting when compared with non-use. More rigorous, prospective study is warranted.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134416141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is There Gender Disparity in Orthopedic Surgery Resident Research Productivity?","authors":"Bridget K. Ellsworth, Nicolas Pascual-Leone, Preston W. Gross, Kathryn A. Barth, Shevaun M. Doyle","doi":"10.1177/15563316221150934","DOIUrl":"https://doi.org/10.1177/15563316221150934","url":null,"abstract":"Background: Compared with male senior authors, female senior authors publish less often in orthopedic journals than expected based on their population proportion. It is unknown whether this trend is also present among orthopedic trainees. Purpose: We sought to determine whether there is a gender discrepancy in the publication volume and authorship status among orthopedic residents. Methods: We conducted a cross-sectional analysis to evaluate the research productivity of male and female orthopedic residents. The top 10 ranked US orthopedic surgery residencies by research output in 2021–2022 were obtained from Doximity. Residents’ names were recorded from each institution’s residency website. We classified each resident as male or female, searched on PubMed, and recorded the number of publications relevant to orthopedic surgery. Resident contribution to each publication was recorded as either a first/last author or a middle author. To assess contributions by postgraduate year, we compared male and female junior residents (PGY1-3) and senior residents (PGY4-5) using the number of total publications, middle author publications, first/last author publications, and the difference between the number of middle and first/last author publications. Results: Among the 335 male and 117 female residents included, male residents had more total publications than female residents. Among PGY4-5, male residents had more total publications and middle author publications. There was no difference in the number of first/last author publications between male and female PGY4-5 residents. Conclusions: Our cross-sectional analysis found that in the 2021–2022 academic year, male orthopedic surgery residents published more often than female residents, although among PGY4-5 residents, we found no gender differences in number of first/last author publications. The difference in total publications among PGY4-5 residents is likely due to differences in middle author publications. Future research should consider residents’ self-identified gender, including non-binary and gender-fluid identity.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132764729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Descriptive Epidemiology of Injuries Sustained in National Collegiate Athletic Association Men’s and Women’s Lacrosse, 2004–2005 Through 2013–2014 Seasons","authors":"Ambar Garcia, Lauren H. Redler","doi":"10.1177/15563316221147204","DOIUrl":"https://doi.org/10.1177/15563316221147204","url":null,"abstract":"Background: Men’s and women’s lacrosse operate with significantly different rules, equipment, and contact. Previous studies have assessed injury rates (IRs) in either men’s or women’s lacrosse, but a few studies have compared injury patterns in the National Collegiate Athletic Association (NCAA) men’s and women’s lacrosse. Purpose: We sought to examine whether there were differences in injury type, mechanism, setting, and time loss in men and women playing lacrosse in the NCAA. Methods: We performed a retrospective case-control study using data collected by the NCAA Injury Surveillance Program (ISP) during a 10-season period (2004–2005 to 2013–2014). The data were assessed for potential differences in injuries between male and female lacrosse players and analyzed to obtain descriptive statistics through calculations of rates, percentages, and confidence intervals (CIs). Main outcomes measured were IRs per 1000 athletic exposures (AEs) and injury rate ratios (IRRs) with 95% CIs. Results: The IRs were 5.19 per 1000 AEs in women’s lacrosse and 6.52 per 1000 AEs in men’s lacrosse. Men had more injuries overall than women in competitions and practices and in preseason, regular season, and postseason play. Preseason IRs were higher than the regular season, and competition injuries were greater than practice injuries in both sexes. Women had more injuries to the head/face, knee, lower leg, and foot. Sprains, strains, concussions, and contusions were the most common types of injuries in both sexes. Overuse/gradual onset, cartilage, concussion, inflammation, and tendinosis injuries were more common in women than men. Injuries in men resulted in time loss more often than injuries in women. Conclusions: Our retrospective study’s findings suggest that there were differences in injury patterns between men’s and women’s lacrosse. Future prospective research should assess whether these disparities are due to differences in equipment and rules and whether changes to these factors can reduce injuries.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132757994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}