Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews最新文献

{"title":"Expanding Orthopaedic Care Across the Pacific: A Global Health Model Translated Into the Pacific Islands Orthopaedic Association.","authors":"Philip M Lee, Sasha Rovinsky, Mason J A Caldwell, Andrew T Nguyen, Eli M Snyder, Desmond Soares, Tu'uau S Mauiliu, Areta Samuelu, Seioh Ezaki, Kelly Withy, Robin Kamal, Lauren Shapiro, Richard A Gosselin, David Rovinsky","doi":"10.5435/JAAOSGlobal-D-26-00088","DOIUrl":"10.5435/JAAOSGlobal-D-26-00088","url":null,"abstract":"<p><p>Pacific Island countries face persistent and profound gaps in access to essential orthopaedic care driven by geographic dispersion, fragile infrastructure, and workforce shortages. Reliance on overseas medical referral schemes, often politically influenced and consuming substantial portions of limited health budgets, can improve access for individual patients but fails to build local capacity or ensure timely intervention for trauma and infection. Evidence from low- and middle-income settings demonstrates that \"train-in-place\" education models can expand the workforce, improve care processes, and reduce preventable disability. The Pacific Islands Orthopaedic Association exemplifies a regionally tailored approach through a tuition-free curriculum that retains trainees within their home health systems, reintegrates graduates as educators, and progressively reduces dependence on expatriate teams. To translate this model into durable system-level gains, parallel investments in procurement, supply chains, biomedical maintenance, and enabling policy are essential. Standardized capacity assessments encompassing workforce, case mix, infrastructure, readiness, and overseas medical referral utilization, coupled with regional train-in-place orthopaedic education, offer a scalable pathway to timely, high-quality care across the Pacific. The purpose of this article was to evaluate the current literature on strategies to increase access to musculoskeletal care in the Pacific, with a focus on home-training programs in the Pacific and their cost effectiveness.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Studying the Natural History of the Knee Joint.","authors":"Kellen L Mulford, Marisa Ulrich, Sami Saniei, Cody C Wyles","doi":"10.5435/JAAOSGlobal-D-25-00440","DOIUrl":"10.5435/JAAOSGlobal-D-25-00440","url":null,"abstract":"<p><p>By the time the orthopaedic surgeon sees a patient with symptomatic knee osteoarthritis, the disease has already progressed to an advanced stage. As a result, studying the full natural history of the knee is especially difficult. A few large longitudinal cohorts, the Osteoarthritis Initiative and Multicenter Osteoarthritis Study in particular, provide the bulk of the data for most extant studies. In this review, we report on the current state of knowledge regarding the study of the natural history of the knee, including the difficulties of natural history research, the tools used to assess knee osteoarthritis, the major longitudinal studies in knee osteoarthritis, and the ability of early interventions to modify natural history. In addition, we will preview what is possible using artificial intelligence and newer large longitudinal cohorts.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence Scribes in Orthopaedic Surgery: A Narrative Review.","authors":"Fatumastar O Adan, Kehinde S Agoro, Venkat Rao, Brian P Cunningham, Allison J Rao","doi":"10.5435/JAAOSGlobal-D-25-00398","DOIUrl":"https://doi.org/10.5435/JAAOSGlobal-D-25-00398","url":null,"abstract":"<p><strong>Introduction: </strong>The growing applications of artificial intelligence (AI) is transforming the healthcare landscape by reshaping diagnostics, workflow operations, and clinical decision making. Among its most promising application in surgery is the development of AI scribes designed to reduce the burden of documentation. This review examines standard and emerging documentation tools with a focus on orthopaedic surgery.</p><p><strong>Methods: </strong>A narrative review of the applications of AI and AI scribes in orthopaedic surgery was done. Literature searches were conducted using PubMed and Google Scholar through July 2025. Keywords included AI, documentation, scribes, AI scribes, and electronic health record. Articles were included if they focused on clinical documentation with particular relevance to orthopaedic surgery. In addition, a targeted review of commercially available AI scribe platforms was conducted, extracting advertised features including orthopaedic note tailoring, EHR integration, security policies, cost, strengths, and potential areas of consideration.</p><p><strong>Results: </strong>The standard documentation approaches, including human transcription services, medical scribes, and frontend speech recognition software, provide partial relief from documentation burden but remain limited by cost, scalability, and workflow integration. Although human transcription services and medical scribes can capture nuanced clinical information and provide real-time support, they are constrained by turnaround time, financial burden, and scalability challenges. By contrast, emerging AI scribe platforms offer EHR-integrated, ambient documentation solutions but vary widely in cost, scalability, and orthopaedic-specific customization, highlighting ongoing challenges in addressing the unique documentation demands of orthopaedic practice.</p><p><strong>Discussion: </strong>AI scribes represent a promising evolution in clinical documentation for orthopaedic surgery. Although early results are encouraging, further specialty-specific validation is needed to address orthopaedic workflows, ensure accuracy, and define optimal implementation strategies; however, ethical considerations and patient privacy protections remain essential to safe and responsible implementation.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigation-Assisted Extra-articular Approach for Curettage of a Subchondral Bone Cyst of the Humeral Trochlea.","authors":"Tasuku Miyake, Ryoya Shiode, Kunihiro Oka, Satoshi Miyamura, Toru Iwahashi, Natsuki Yamamoto, Hiroki Kondo, Tsuyoshi Murase, Seiji Okada, Hiroyuki Tanaka","doi":"10.5435/JAAOSGlobal-D-26-00107","DOIUrl":"10.5435/JAAOSGlobal-D-26-00107","url":null,"abstract":"<p><p>Subchondral bone cysts are intraosseous cystic lesions typically associated with degenerative joint diseases in weight-bearing joints; however, their occurrence in the humeral trochlea is extremely rare. We report a case of a 19-year-old Japanese archer who presented with a 2-year history of right elbow pain. CT revealed an 8- × 4- × 4-mm cystic lesion with partial disruption of the subchondral bone plate on the lateral aspect of the humeral trochlea. As arthroscopic access is technically challenging and intra-articular curettage through the joint surface would damage the cartilage, a navigation-assisted extra-articular approach was selected. A patient-specific three-dimensional surgical plan was designed to achieve cylindrical excision of the lesion and was reconstructed with a β-tricalcium phosphate bone substitute. Postoperative CT scans confirmed complete removal of the cyst. Postoperatively, the patient's elbow pain gradually improved and had completely resolved at 14 months. This case demonstrates that navigation-assisted extra-articular curettage is a feasible technique for treating deep subchondral bone cysts of the humeral trochlea while preserving the articular cartilage.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased Odds of Perioperative Complications Following Lumbar Diskectomy Among Patients With a Colostomy.","authors":"Lucas Y Kim, Jonathan N Grauer","doi":"10.5435/JAAOSGlobal-D-25-00343","DOIUrl":"https://doi.org/10.5435/JAAOSGlobal-D-25-00343","url":null,"abstract":"<p><strong>Introduction: </strong>Lumbar diskectomy is a commonly performed surgery for which patients may present with conditions predisposing to adverse outcomes, such as the presence of a colostomy. This study aimed to characterize patients undergoing lumbar diskectomy with versus without colostomy and determine whether matched cohorts had differential rates of postoperative complications.</p><p><strong>Methods: </strong>Adult patients undergoing primary lumbar laminotomy/diskectomy were identified from the administrative 2010 to 2022 Q4 PearlDiver M165 database. Two subcohorts were created: (1) patients with a diagnosis code for colostomy without any history of ostomy reversal procedures and (2) patients without colostomy. Those with versus without colostomy were matched and compared for incidence of 90-day postoperative adverse events or secondary surgery within 5 years using multivariable logistic regression, controlling for patient age, sex, and Elixhauser Comorbidity Index (ECI).</p><p><strong>Results: </strong>Of 365,161 lumbar diskectomy patients, colostomy was present for 355. Following matching, colostomy patients were at higher odds of sepsis (odds ratio [OR] 14.52, P < 0.0001), surgical site infection (OR 6.92, P < 0.0001), wound complications (OR 8.85, P < 0.0001), acute kidney injury (OR 5.26 P < 0.0001), urinary tract infection (OR 4.72, P < 0.0001), pneumonia (OR 3.92, P = 0.0002), as well as 5-year revision lumbar surgeries (OR 2.85, P < 0.0001).</p><p><strong>Conclusion: </strong>Colostomies are rarely present at the time of lumbar diskectomy, but when present are associated with higher odds of perioperative adverse outcomes (mostly infectious) and 5-year revision lumbar surgeries. These findings may help guide shared decision making and development of risk mitigation strategies.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plating of the Pelvis and Acetabulum via the Laparoscopic Technique: An Alternative Method for ORIF.","authors":"Siyuan Qing, Shaobo Zhang, Ruizhe Zhao, Guqi Hong, Jie Li, Xiaodong Qin","doi":"10.5435/JAAOSGlobal-D-25-00273","DOIUrl":"https://doi.org/10.5435/JAAOSGlobal-D-25-00273","url":null,"abstract":"<p><strong>Introduction: </strong>Open reduction and internal fixation (ORIF) is a standard treatment for pelvic and acetabular fractures, but it is associated with great trauma and a high incidence of complications. The purpose of this retrospective study was to investigate whether laparoscopy can be used as an alternative to standard ORIF in the treatment of pelvic and acetabular fractures.</p><p><strong>Materials and methods: </strong>This study included 15 patients with pelvic and acetabular fractures who underwent laparoscopy. The surgical time, intraoperative blood loss, and surgery-related complications of all the patients were recorded. The Matta score was used to evaluate the quality of fracture reduction after the surgery, and the modified Merle d'Aubigne & Postel score was used to evaluate hip joint function at the last follow-up.</p><p><strong>Results: </strong>The mean patient age was 50.8 ± 16.4 years, and the average surgical time was 224.4 ± 74.2 min. The intraoperative bleeding volume was 100.0 (50.0, 300.0) mL. The quality of fracture reduction was excellent in 10 patients and satisfactory in five patients. Hip function was excellent in seven patients and good in eight patients, with a score of 17.0 (17.0, 18.0). Intraoperative vascular injury occurred in two patients. Peritoneal rupture occurred in one patient. Partial loosening of the internal fixation was found in one patient at the last follow-up.</p><p><strong>Conclusion: </strong>Laparoscopic treatment of pelvic and acetabular fractures can achieve good clinical results, although there were 20% vascular and peritoneal complications and can be used as an alternative to ORIF in some cases.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing Utilization of Advanced Practice Providers in Spine Surgery from 2013 to 2022: A Medicare Part B Analysis.","authors":"Mark Miller, Matthew Meade, Maneesha Palakurthi, Ruchir Nanavati, Nithin Gupta, William T DiCiurcio, Omar Sbaih, Matthew B Sherman, Christopher Kepler, Gregory Schroeder, Barrett Woods","doi":"10.5435/JAAOSGlobal-D-25-00433","DOIUrl":"10.5435/JAAOSGlobal-D-25-00433","url":null,"abstract":"<p><strong>Introduction: </strong>In modern healthcare systems, the role of advanced practice providers (APPs), including nurse practitioners (NP) and physician assistants (PA), has increased in many settings, in step with the increased demand for healthcare services. The purpose of the present investigation was to evaluate trends in the prevalence, reimbursement, and characteristics of care provided by APPs in the treatment of spinal disorders in the United States from 2013 to 2022.</p><p><strong>Methods: </strong>A retrospective cohort study using the publicly available Medicare Provider Utilization and Payment database from the Centers for Medicare and Medicare Services was conducted on diagnostic, procedural, and therapeutic services provided by advanced practice providers from 2013 to 2022. Provider-type and billing codes were used to identify healthcare professionals providing care for spine patients, such as ordering radiographs, assisting in surgical procedures, or performing office visits. Trends were analyzed using linear regression modeling with projections generated through 2030.</p><p><strong>Results: </strong>Over the study period, the number of surgeons involved in spine care decreased from 3953 (71.2%) in 2013 to 3951 (66.7%) in 2022. The number of APPs who billed for the care of spine patients increased 23.3% from 1600 in 2013 to 1974 in 2022. The most common services billed for by APPs included radiographs and office visits. There were increased odds (OR: 1.20, 95% CI, 1.03-1.41, P < 0.001) of a spine provider in rural areas being an APP versus spine surgeon. Forecasting analysis for 2030 demonstrated continuation of these trends regarding the number of providers, services, and geographic distribution.</p><p><strong>Discussion: </strong>Increased utilization of APPs in the care of patients with spinal pathology is likely to continue with the growing prevalence of patients with spinal disorders.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of Alcohol Use Disorder and Management in Orthopaedic Patients: A Retrospective Analysis.","authors":"Travis Jebackumar, Justin Jebackumar, Bryce F Rizvanović, Ashley C Helle, Samantha Portis, Kylee Rucinski","doi":"10.5435/JAAOSGlobal-D-25-00483","DOIUrl":"10.5435/JAAOSGlobal-D-25-00483","url":null,"abstract":"<p><strong>Introduction: </strong>Alcohol use disorder (AUD) is a prevalent, relapsing condition. Despite well-documented links between alcohol misuse and adverse health outcomes, the role of AUD in orthopaedic surgery is underexplored, and systematic screening remains uncommon. The aim of this study was to examine the incidence of alcohol use and potential misuse among orthopaedic patients and assessed whether patients flagged for risk engaged in documented discussions about alcohol use with their care teams.</p><p><strong>Methods: </strong>We retrospectively reviewed intake data from orthopaedic trauma, spine, bone health, and general registries between May 2020 and April 2025. Alcohol use was initially assessed with a nonstandardized intake questionnaire and later with the validated Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) tool. Patients meeting thresholds for possible misuse were flagged. Clinical notes were reviewed to determine whether flagged patients had alcohol use discussed by their orthopaedic team.</p><p><strong>Results: </strong>Among 99,269 patients screened, 67.9% reported some alcohol use, and 2.5% reported a personal history of AUD. Of 1040 patients completing the AUDIT-C, 29.2% screened positive for potential misuse; 11.1% of bone health patients also met criteria for at-risk drinking. Only 80 of 718 flagged patients (11.1%) had a documented alcohol-related discussion, with higher rates in bone health registries and among older patients.</p><p><strong>Conclusion: </strong>Alcohol use and misuse are common among orthopaedic patients, yet systematic screening and discussion are infrequent. Integrating validated screeners such as AUDIT-C into routine intake and supporting clinicians with training and referral pathways represent critical opportunities to improve patient safety and orthopaedic outcomes.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased Social Deprivation Correlates With Worse Postoperative Pain and Anxiety PROMIS Scores in Distal Femur Fractures.","authors":"Ndéye F Guissé, Susan Thapa, Arakua Welbeck, Nichelle Enata, Anna N Miller","doi":"10.5435/JAAOSGlobal-D-25-00066","DOIUrl":"https://doi.org/10.5435/JAAOSGlobal-D-25-00066","url":null,"abstract":"<p><strong>Introduction: </strong>The area deprivation index (ADI) is a valuable tool for assessing patient risk holistically, yet there is limited research on the link between area deprivation and patient-reported outcomes in adult orthopaedic trauma patients after surgery. This study examines the association of ADI with both objective and subjective outcomes after surgical treatment of distal femur fractures.</p><p><strong>Methods: </strong>This retrospective cohort study included patients aged 18 to 80 years who presented with traumatic distal femur fractures over 7 years and were treated surgically (OTA/AO Classification 33A, 33B, and 33C) at a level 1 trauma center. Data collected included patient demographics (age, sex, and race), body mass index, tobacco and substance use, medical comorbidities, and insurance status. Patients were grouped by ADI as either most deprived (>85th percentile) or less deprived (<85th percentile), using the Neighborhood Atlas. Patient-reported outcomes (physical function, anxiety, pain, and depression) were collected at 0 to 3, 3 to 9, and 9 to 12 months postoperatively. Objective outcomes included complications, readmissions, reoperations, and 1-year mortality.</p><p><strong>Results: </strong>A total of 107 patients (58 females, 49 males; mean age 53.8 years) were studied. The most deprived group was younger (48.2 vs. 57.9 years) and had more Black patients (62.2% vs. 14.5%) compared with the less deprived group, which was predominantly White (83.9% vs. 35.6%). Fewer in the most deprived group had private insurance (11.9% vs. 31.7%), and more were uninsured (19.1% vs. 5%). Both groups showed notable improvements in physical function, but the most deprived group reported higher anxiety and pain scores at 3 months. Anxiety equalized at 6 months, but pain remained higher at 1 year.</p><p><strong>Conclusions: </strong>Patients with higher social deprivation experienced increased pain and anxiety despite similar objective outcomes. These findings should arm orthopaedic traumatologists with more insight on caring for socially deprived patients with a more nuanced approach prioritizing their risk profiles with focus on mental health and pain management.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior Lumbar Fusion Is Being Performed for Patients of Increasing Comorbidity Burden Over the Years, but Adverse Events Are Not Going Up.","authors":"Adam D Winter, Anthony E Seddio, Michael J Gouzoulis, Beatrice M Katsnelson, Wesley Day, Daniel R Rubio, Arya G Varthi, Jonathan N Grauer","doi":"10.5435/JAAOSGlobal-D-25-00379","DOIUrl":"10.5435/JAAOSGlobal-D-25-00379","url":null,"abstract":"<p><strong>Introduction: </strong>Comorbidity indices, such as the Elixhauser Comorbidity Index (ECI), are increasingly used to track comorbidities, but annual trends and association with adverse outcomes following posterior lumbar fusion (PLF) have not been well characterized.</p><p><strong>Methods: </strong>Patients who underwent single-level PLF ± interbody fusion were identified from the 2010 to 2022 PearlDiver M165 administrative database and stratified into ECI cohorts that correlated with any, minor, and severe adverse events (AAE, MAE, SAE). ECI trends were tracked over the years and associated 90-day adverse events determined. Odds of such adverse events were analyzed using multivariate logistic regression controlling for age and sex. Linear regression was used to describe this association.</p><p><strong>Results: </strong>The median ECI of patients who underwent PLF in 2010 was 1 (inner quartile range [IQR]: 0-2) versus 2022 when it was 5 (IQR: three-8) (P < 0.001). Despite this increase in ECI over the years, the incidence of adverse events did not increase in 2022 vs 2010: AAE (10.1% vs 11.1%, P = 0.005), MAE (7.5% vs 7.9%, P = 0.197), and SAE (4.6% vs 4.8%, P = 0.392). The increase in odds ratio (OR) of AAEs increased with ECI gradually up to ECI 5 to 6 (slope = 0.49, R2 = 0.96) but then steeper after ECI 5 to 6 (slope = 1.41, R2 = 0.96).</p><p><strong>Discussion: </strong>Despite a year-to-year increase in ECI among PLF patients, the incidence of adverse events has not mirrored this trend, likely reflecting improvements in perioperative management and preoperative patient optimization over time.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13406117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}