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Momenzadeh K, Yeritsyan D, Mortensen S, Kheir N, Khak M, Caro D, Kahe F, Abbasian M, Mo C, McNichol M, Paschos N, Nazarian A. While the Incidence of Venous Thromboembolism After Shoulder Arthroscopy Is Low, the Risk Factors Are a Body Mass Index Greater than 30 and Hypertension. Arthrosc Sports Med Rehabil 2024; 6:100815. [PMID: 38149088 PMCID: PMC10749995 DOI: 10.1016/j.asmr.2023.100815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/20/2023] [Indexed: 12/28/2023] Open
Abstract
Purpose This study aims to determine the overall incidence of venous thromboembolism (VTE) following shoulder arthroscopy and to define potential risk factors associated with its development that may help define guidelines for the use of thromboprophylaxis. Methods A systematic review was performed using PubMed, Embase, Web of Science, CINAHL, and Cochrane databases per PRISMA guidelines. The search terms consisted of variations of "Venous Thromboembolism" and "Shoulder Arthroscopy." Information regarding arthroscopy indication, risk factors, outcomes, and patient demographics was recorded and analyzed, and pooled odds ratios were reported for each variable. Results Six hundred eighty-five articles were identified in the initial search, and 35 articles reported DVT, PE, or VTE incidence following shoulder arthroscopy. Seventeen nonoverlapping articles with a unique patient population incidence rates. Four articles were then used for subgroup meta-analysis. The incidence rate of VTE was 0.24%, ranging from 0.01% to 5.7%. BMI >30 (OR = 1.46; 95% CI = [1.22, 1.74]; I2 = 0%) and hypertension (OR = 1.64; 95% CI = [1.03, 2.6]; I2 = 75%) were significant risk factors (P < .05) for developing VTE following shoulder arthroscopy. Diabetes (OR = 1.2; 95% CI = [0.97, 1.48]; I2 = 0%), insulin-dependent diabetes (OR = 5.58; 95% CI = [0.12, 260.19]; I2 = 85%), smoking (OR = 1.04; 95% CI = [0.79, 1.37]; I2 = 12%), male sex (OR = 0.95; 95% CI = [0.49, 1.85]; I2 = 86%) and age over 65 (OR = 4.3; 95% CI = [0.25, 72.83]; I2 = 85%) were not associated with higher VTE risk. Conclusion The VTE incidence following shoulder arthroscopy is low at 0.24%. Patients with BMI >30 and hypertension are at a higher risk for VTE after shoulder arthroscopy. Level of Evidence Level IV, systematic review and meta-analysis of Level I-IV studies.
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Affiliation(s)
- Kaveh Momenzadeh
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Diana Yeritsyan
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Sharri Mortensen
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Nadim Kheir
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Mohammad Khak
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Daniela Caro
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Farima Kahe
- Cardiovascular Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Mohammadreza Abbasian
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Chen Mo
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Megan McNichol
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Nikolaos Paschos
- Orthopaedic Surgery Department, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia
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Triplet JJ, Schuette HB, Cheema AN, Marigi EM, Hassett LC, Barlow JD, Camp CL, Morrey ME, Sperling JW, Sanchez-Sotelo J. Venothromboembolism following shoulder arthroscopy: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:464-468. [PMID: 37588470 PMCID: PMC10426627 DOI: 10.1016/j.xrrt.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Venous thromboembolic events (VTEs) following orthopedic surgery may lead to serious morbidity and mortality. Fortunately, VTEs following upper extremity procedures are uncommon. However, the true incidence is likely underreported. The aim of this study is to provide a systematic review, excluding large database studies, to report on the incidence of VTEs following shoulder arthroscopic procedures. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a systematic review of multiple databases was performed. A comprehensive search of several databases from inception to September 1, 2021, limited to English language and excluding animal studies, was designed and conducted. Studies were screened by 2 independent reviewers. A decision to exclude studies from large surgical or insurance claim databases was made to minimize the risk of including overlapping data points in this systematic review. Results Thirteen studies met inclusion and exclusion criteria and form part of this systematic review. A total of 32,407 patients were included in this study. Among these patients, the deep vein thrombosis, pulmonary embolism, and overall VTE rates were 0.15%, 0.08%, and 0.21%, respectively. Among the patients specified to have undergone arthroscopic rotator cuff repair, the rate of deep vein thrombosis, pulmonary embolism, and overall VTE was 0.71%, 0.37%, and 1.04%, respectively. Conclusion While symptomatic VTEs are rare following shoulder arthroscopic procedures, surgeons must be aware that they still account for a certain number of postoperative complications. Factors such as operative time, open procedures, obesity, and altitude may increase the risk of postoperative VTE although conflicting data exist. Current literature supports the idea that chemical antithrombotic prophylaxis likely provides no significant advantage over early mobilization in reducing VTEs following shoulder arthroscopy in low-risk patients.
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Yi BC, Gowd AK, Agarwalla A, Chen E, Amin NH, Nicholson GP, Romeo AA, Liu JN. Efficacy of the modified Frailty Index and the modified Charlson Comorbidity Index in predicting complications in patients undergoing operative management of proximal humerus fracture. J Shoulder Elbow Surg 2021; 30:658-667. [PMID: 32650081 DOI: 10.1016/j.jse.2020.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/08/2020] [Accepted: 06/15/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Comorbidity indices such as the 5-factor modified Frailty Index (mFI-5) and modified Charlson Comorbidity Index (mCCI) are widely used in outcomes research. METHODS A total of 3893 patients who underwent total shoulder arthroplasty (n=975), hemiarthroplasty (n=495), or open reduction and internal fixation (n=2423) for the treatment of proximal humerus fracture from 2005-2017 were identified from the National Surgical Quality Improvement Program database. Data regarding demographics, comorbidities, American Society of Anesthesiologists class, and postoperative complications were collected, and the mFI-5 and mCCI were calculated for each case. Multivariate logistic regression models and receiver operating characteristic curve analyses were performed. RESULTS The patient population had a mean age of 68.0 ± 13.2 years, body mass index of 29.1 ± 8.1 and mean operative time of 119.9 ± 55.5 minutes. The most common complications within this cohort were extended length of stay (4 days or more) (1085/3893; 27.87%), transfusion (377/3893; 9.68%), unplanned reoperation (97/3893; 2.49%), urinary tract infection (43/3893; 1.10%), death (42/3893; 1.08%), and deep vein thrombosis (40/3893; 1.03%). After accounting for patient demographics, the mFI-5 (odds ratio [OR] = 1.105, P < .001) and mCCI (OR = 1.063, P < .001) were significantly associated with incidence of any adverse event. Both comorbidity indices had low positive predictive value and high negative predictive value for all adverse events. CONCLUSION The comorbidity indices mCCI and mFI-5 are both strongly associated with adverse events but have moderate ability to predict complications following surgical treatment of proximal humerus fractures.
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Affiliation(s)
- Brendan C Yi
- School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Eric Chen
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Nirav H Amin
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | | | - Anthony A Romeo
- Department of Orthopaedic Surgery, The Rothman Institute, New York, NY, USA
| | - Joseph N Liu
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA.
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Rate of venous thromboembolism after surgical treatment of proximal humerus fractures. Arch Orthop Trauma Surg 2021; 141:403-409. [PMID: 32504179 DOI: 10.1007/s00402-020-03505-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 05/31/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The rate of venous thromboembolism following surgical treatment of proximal humerus fractures is not well established. METHODS A retrospective review of all patients undergoing surgical treatment for proximal humerus fractures from September 2011 to May 2017 was performed. Included patients received only mechanoprophylaxis using sequential compression devises. All patients had at least 6 months follow-up. The primary outcome of interest was the rate of postoperative DVT and PE. RESULTS 131 patients underwent 139 surgeries for proximal humerus fracture. After exclusion criteria were applied, 92 patients who underwent 92 surgeries were included. There were 47 females and 45 males. Five (5.4%) were taking Aspirin 81 mg preoperatively. There were 76 cases of open reduction and internal fixation (ORIF), 8 cases of reverse total shoulder arthroplasty, 4 cases of hemiarthroplasty, 3 cases of closed reduction percutaneous pinning (CRPP), 1 case of open reduction without fixation. 53.3% of patients had one or more risk factors for VTE. There were no cases of fatal PE or DVT. There were two cases of symptomatic PE (2.2%) following one ORIF and one CRPP. There was one additional case of asymptomatic PE found incidentally after ORIF. Overall VTE rate was 3.3%. Fisher's exact test yielded that there was no significant association between the presence of VTE risk factors and prevalence of VTE postoperatively (p = 0.245). CONCLUSIONS The incidence of symptomatic VTE after surgery for proximal humerus fractures is low. Chemical VTE prophylaxis in patients after surgical fixation for proximal humerus fractures is not universally indicated. Selective prophylaxis for patients with systemic risk factors may be warranted.
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Aziz KT, Best MJ, Shi BY, Srikumaran U. Missing Data in the National Surgical Quality Improvement Program Database: How Does It Affect the Identification of Risk Factors for Shoulder Surgery Complications? Arthroscopy 2020; 36:1233-1239.e3. [PMID: 31954805 DOI: 10.1016/j.arthro.2019.12.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 12/13/2019] [Accepted: 12/13/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The main purpose of this study was to establish whether different approaches to handling missingness affect the determination of risk factors associated with 30-day postoperative major and minor complications. A secondary purpose was to determine the frequency of missingness in the National Surgical Quality Improvement Program (NSQIP) records of patients who underwent shoulder surgery. METHODS We queried the American College of Surgeons NSQIP database using Current Procedural Terminology codes to identify patients who underwent shoulder surgery from 2011 to 2016 (n = 61,963). Data on major and minor postoperative complications were extracted. We also extracted data on patient characteristics, comorbidities, American Society of Anesthesiologists classifications, and preoperative laboratory values. We calculated the percentages of missingness for each variable. Each variable was then evaluated for associations with major and minor complications by using multivariable regression and 4 methods of handling missingness (involving imputation or exclusion, depending on the completeness of the data set). For 10 variables, the method using no exclusion or imputation produced higher odds of major complications compared with imputation. For 5 variables, the method using no exclusion or imputation produced higher odds of minor complications compared with imputation. RESULTS Only 6.5% of all patients had no missing data (n = 4,042), whereas 44% had <10% missingness (n = 27,165). Fewer variables were associated with both major and minor complications after shoulder surgery when patient records with missing data were excluded from analysis. CONCLUSIONS Different methods of handling missingness produced different odds ratios for some variables when determining risk factors for complications after shoulder surgery. LEVEL OF EVIDENCE III, Case control study.
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Affiliation(s)
- Keith T Aziz
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Matthew J Best
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Brendan Y Shi
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD.
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Salzler MJ, Engler ID, Li AX, Jorgensen AH, Cassidy C, Tybor DJ. Comparing Reported Complication Rates in Shoulder Arthroplasty Between 2 Large Databases. Orthopedics 2020; 43:113-118. [PMID: 31930411 DOI: 10.3928/01477447-20200107-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/14/2019] [Indexed: 02/03/2023]
Abstract
Large databases are commonly used to analyze surgical outcomes. Recent studies have suggested that there are differences in complication rates between databases across certain procedures, but the reasons for these differences are not fully understood. The goal of this study was to compare complications of shoulder arthroplasty across databases as well as to interpret the causes of any differences. The authors compared complication rates for shoulder arthroplasty as reported by the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) and the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) from 2006 to 2010. The authors then restricted NIS data solely to hospitals that also contributed to NSQIP to provide a more direct comparison of the patient populations. The authors identified 48,287 discharges reported in NIS and 1679 discharges reported in NSQIP for patients who underwent shoulder arthroplasty. The complication rate for shoulder arthroplasty was significantly higher in the NIS population (12.6%; 95% confidence interval, 12.0%-13.2%) than in the NSQIP population (5.60%; 95% confidence interval, 4.59%-6.81%). When NIS data were restricted solely to hospitals that also participated in NSQIP, the rate of complications remained higher, at 13.4% (95% confidence interval, 11.2%-15.8%), and the rate increased relative to the nonrestricted data. The databases compared in this study had statistically significant differences in reported complication rates for shoulder arthroplasty. This difference persisted when NIS data were restricted to hospitals that also participated in NSQIP, suggesting that differences in database design contribute to important differences in data. Orthopedic surgeons and administrators must use caution when using complication rates derived from large database studies. [Orthopedics. 2020;43(2):113-118.].
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Malik AT, Barlow JD, Jain N, Khan SN. Incidence, risk factors, and clinical impact of non-home discharge following surgical management of proximal humerus fractures. Shoulder Elbow 2019; 11:430-439. [PMID: 32269603 PMCID: PMC7094066 DOI: 10.1177/1758573218809505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 01/07/2023]
Abstract
INTRODUCTION There has been a reported increase in the number of proximal humerus fractures being surgically managed. In an attempt to manage increasing costs associated with increasing volume, there is a need for identification of factors associated with discharge destinations. METHODS The 2012-2016 American College of Surgeons-National Surgical Quality Improvement Program database was queried using Current Procedural Terminology codes for open reduction internal fixation, hemiarthroplasty, and total shoulder arthroplasty being performed for proximal humerus fractures. RESULTS Five hundred and seventy-six (21.5%) patients had nonhome discharge disposition. Following adjusted analysis, age > 65 years (p < 0.001), partially dependent functional health status prior to surgery(p = 0.027), inpatient surgery (p = 0.010), American Society of Anesthesiologists (ASA) grade>II (p < 0.001), transfer from nursing home/chronic care facility (p < 0.001), undergoing a total shoulder arthroplasty versus open reduction internal fixation (p = 0.012), length of stay > 2 days (p < 0.001), and the occurrence of any predischarge complication (p < 0.001) were significant predictors associated with a nonhome discharge disposition. CONCLUSION The study identifies significant risk factors associated with a nonhome discharge and assesses clinical impact of nonhome discharge destination on postdischarge outcomes. Providers can utilize these data to preoperatively risk stratify those at an increased risk of a nonhome discharge, counsel patients on discharge expectations, and tailor a more appropriate postoperative course of care.
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Affiliation(s)
| | | | | | - Safdar N Khan
- Safdar N Khan, Department of Orthopaedic
Surgery, Wexner Medical Center at The Ohio State University Columbus, Ohio, USA.
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Padaki AS, Boddapati V, Mathew J, Ahmad CS, Jobin CM, Levine WN. The effect of age on short-term postoperative complications following arthroscopic rotator cuff repair. JSES OPEN ACCESS 2019; 3:194-198. [PMID: 31709361 PMCID: PMC6835001 DOI: 10.1016/j.jses.2019.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Hypothesis The purpose of this study was to assess short-term outcomes, including the rates of medical complications, non-home discharge, overnight hospital stay, and 30-day readmission, associated with patient age at the time of rotator cuff repair. Methods This study used National Surgical Quality Improvement Program data from 2005 to 2016 to analyze patients who underwent arthroscopic rotator cuff repair (ARCR). Patients were stratified into age cohorts of younger than 55 years, between 55 and 65 years, or older than 65 years. Outcomes including postoperative complications, discharge destination, and readmission were compared between the age cohorts using multivariate analysis. Results We identified 23,974 patients undergoing ARCR: 8344 patients (34.8%) were younger than 55 years, 9166 (38.4%) were aged between 55 and 65 years, and 6434 (26.8%) were older than 65 years. Older patients were more likely to be female patients and to have a lower body mass index, more medical comorbidities, shorter operative duration, dependent functional status, and higher American Society of Anesthesiologists classification. Patients older than 65 years had a higher rate of total complications (odds ratio [OR], 1.99; P = .003), respiratory complications (OR, 2.99; P = .023), urinary tract infections (OR, 6.94; P < .001), overnight hospital stay (OR, 1.49; P < .001), and unplanned hospital readmission (OR, 1.50; P = .040) relative to patients younger than 55 years. There was no increase in complication rates for patients aged between 55 and 65 years. Conclusions Patients older than 65 years have nearly double the odds of having a postoperative complication following ARCR and nearly 3 and 6 times the odds of having a respiratory complication and a urinary tract complication, respectively. Thorough preoperative optimization, including respiratory and urinary care, may be able to decrease complications in select, high-risk patients.
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Affiliation(s)
- Ajay S Padaki
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Venkat Boddapati
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Justin Mathew
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Christopher S Ahmad
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Charles M Jobin
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - William N Levine
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
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Agarwalla A, Gowd AK, Yao K, Bohl DD, Amin NH, Verma NN, Forsythe B, Liu JN. A 15-Minute Incremental Increase in Operative Duration Is Associated With an Additional Risk of Complications Within 30 Days After Arthroscopic Rotator Cuff Repair. Orthop J Sports Med 2019; 7:2325967119860752. [PMID: 31392239 PMCID: PMC6669850 DOI: 10.1177/2325967119860752] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Operative time is a risk factor for short-term complications after orthopaedic procedures; however, it has yet to be investigated as an independent risk factor for postoperative complications after arthroscopic rotator cuff repair. Purpose: To determine whether operative time is an independent risk factor for complications, readmissions, and extended hospital stays within 30 days after arthroscopic rotator cuff repair. Study Design: Descriptive epidemiology study. Methods: The American College of Surgeons National Surgical Quality Improvement Program was queried for all hospital-based inpatient and outpatient arthroscopic rotator cuff repairs (Current Procedural Terminology code 29827) from 2005 to 2016. Concomitant procedures such as subacromial decompression, biceps tenodesis, superior labrum anterior and posterior (SLAP) repair, labral repair, and distal clavicle excision were also included, whereas patients undergoing arthroplasty were excluded from the study. Operative time was correlated with patient demographics, comorbidities, and concomitant procedures. All adverse events were correlated with operative time, while controlling for the above preoperative variables, using multivariate Poisson regression with a robust error variance. Results: A total of 27,524 procedures met inclusion and exclusion criteria. The mean age of patients was 58.4 ± 10.9 years, the mean operative time was 86.9 ± 37.4 minutes, and the mean body mass index was 30.4 ± 7.0 kg/m2. Concomitant biceps tenodesis, glenohumeral debridement, SLAP repair, labral repair, and distal clavicle excision significantly increased operative time (P < .001) but not the risk of adverse events (P > .05). The overall rate of adverse events was 0.88%. After adjusting for demographic and procedural characteristics, a 15-minute increase in operative duration was associated with an increased risk of anemia requiring transfusion (relative risk [RR], 1.27 [95% CI, 1.14-1.42]; P < .001), venous thromboembolism (RR, 1.17 [95% CI, 1.02-1.35]; P = .029), surgical site infection (RR, 1.13 [95% CI, 1.03-1.24]; P = .011), and extended length of hospital stay (RR, 1.07 [95% CI, 1.00-1.14]; P = .036). Conclusion: Although the rate of short-term complications after arthroscopic rotator cuff repair is low, incremental increases in operative time are associated with an increased risk of adverse events such as surgical site infection, pulmonary embolism, transfusion, and extended length of hospital stay. Efforts should be made to maximize surgical efficiency in the operating room through optimal coordination of the staff or increased preoperative planning.
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Affiliation(s)
- Avinesh Agarwalla
- Department of Orthopedic Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Kaisen Yao
- School of Medicine, New York Medical College, Valhalla, New York, USA
| | - Daniel D Bohl
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Nirav H Amin
- Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian Forsythe
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Joseph N Liu
- Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
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Boitano LT, Iannuzzi JC, Tanious A, Mohebali J, Schwartz SI, Chang DC, Clouse WD, Conrad MF. Preoperative Predictors of Discharge Destination after Endovascular Repair of Abdominal Aortic Aneurysms. Ann Vasc Surg 2019; 57:109-117. [DOI: 10.1016/j.avsg.2018.12.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 11/21/2018] [Accepted: 12/06/2018] [Indexed: 01/01/2023]
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Abstract
Venous thromboembolism (VTE) in the orthopaedic literature largely focuses on lower extremity trauma and arthroplasty, with relatively few investigations of VTE after shoulder surgery. Because the rate of shoulder surgery, especially arthroplasty, continues to expand, it is important for practicing surgeons to understand the magnitude of risk, potential consequences, and prevention methods with regard to VTE. VTE after shoulder surgery has been a topic of increasing interest over the past decade, and the purpose of this review is to examine the recent literature on pathophysiology, risk factors, incidence, diagnosis, sequelae, prevention, treatment, and current recommendations regarding VTE after shoulder surgery.
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Gowd AK, Liu JN, Garcia GH, Agarwalla A, Cabarcas BC, Manderle BJ, Verma NN. Open Biceps Tenodesis Associated With Slightly Greater Rate of 30-Day Complications Than Arthroscopic: A Propensity-Matched Analysis. Arthroscopy 2019; 35:1044-1049. [PMID: 30857905 DOI: 10.1016/j.arthro.2018.11.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 11/09/2018] [Accepted: 11/13/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE To compare the early complication risk associated with open biceps tenodesis (OBT) and arthroscopic biceps tenodesis (ABT) and determine which preoperative factors may influence complication rate. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was retrospectively queried from 2008 to 2016 for all procedures with CPT codes for ABT (29828) and OBT (23430). Patients were excluded if they received concomitant rotator cuff repair or shoulder arthroplasty. Patients undergoing OBT and ABT were matched by propensity scores based on age, body mass index, operative time, proportion of smokers, and proportion of concomitant subacromial decompression, distal clavicle excision, SLAP, and debridement. The incidence of adverse events in the 30-day postoperative period was compared. RESULTS A total of 8,032 patients met the inclusion and exclusion criteria. Prior to propensity match, patients receiving OBT and ABT, respectively, differed with respect to age (49.4 ± 13.8 vs 51.4 ± 13.2; P < .001), body mass index (29.6 ± 6.8 vs 29.9 ± 7.0; P = .029), and operative time (91.2 ± 51.3 vs 85.3 ± 43.4; P < .001). Following propensity match, 6,330 remained in the study (3,165 ABT and 3,165 OBT). OBT had significantly greater incidence of any adverse events (1.58% vs 0.95%; P = .032) and anemia requiring transfusion (0.35% vs 0%; P = .001). Multivariate analysis suggested that OBT (relative risk [RR] = 1.7, 95% confidence interval [CI], 1.1-2.7; P = .020), old age (RR = 1.6, 95% CI, 1.0-2.5), history of dyspnea (RR = 3.8, 95% CI, 1.8-7.7; P < .001), and congestive heart failure (RR = 5.5, 95% CI, 1.3-22.7; P = .019) were associated with developing a postoperative adverse event within 30 days of surgery. CONCLUSIONS Both procedures were found to have a low rate of complications, although OBT had a slightly greater (1.58% vs 0.95%) rate of 30-day complications than ABT. Early complication rate should not serve as impetus to direct surgical technique as number needed to treat is high, although ABT may be considered in more high-risk individuals. LEVEL OF EVIDENCE Level III, retrospective comparative database study.
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Affiliation(s)
- Anirudh K Gowd
- Department of Orthopedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Joseph N Liu
- Loma Linda University Medical Center, Loma Linda, California
| | | | - Avinesh Agarwalla
- Department of Orthopedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brandon C Cabarcas
- Department of Orthopedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brandon J Manderle
- Department of Orthopedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Department of Orthopedics, Rush University Medical Center, Chicago, Illinois, U.S.A.
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Predicting Postoperative Destination Through Preoperative Evaluation in Elective Open Aortic Aneurysm Repair. J Surg Res 2019; 235:543-550. [DOI: 10.1016/j.jss.2018.10.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 09/29/2018] [Accepted: 10/25/2018] [Indexed: 12/13/2022]
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15
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Basques BA, Saltzman BM, Mayer EN, Bach BR, Romeo AA, Verma NN, Cole BJ, Weber AE. Resident Involvement in Shoulder Arthroscopy Is Not Associated With Short-term Risk to Patients. Orthop J Sports Med 2018; 6:2325967118816293. [PMID: 30622998 PMCID: PMC6302272 DOI: 10.1177/2325967118816293] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Shoulder arthroscopy is a commonly performed, critical component of orthopaedic residency training. However, it is unclear whether there are additional risks to patients in cases associated with resident involvement. Purpose To compare shoulder arthroscopy cases with and without resident involvement via a large, prospectively maintained national surgical registry to characterize perioperative risks. Study Design Cohort study; Level of evidence, 3. Methods The prospectively maintained American College of Surgeons National Surgical Quality Improvement Program registry was queried to identify patients who underwent 1 of 12 shoulder arthroscopy procedures from 2005 through 2012. Multivariate Poisson regression with robust error variance was used to compare the rates of postoperative adverse events and readmission within 30 days between cases with and without resident involvement. Multivariate linear regression was used to compare operative time between cohorts. Results A total of 15,774 patients with shoulder arthroscopy were included in the study, and 12.3% of these had a resident involved with the case. The overall rate of adverse events was 1.09%. On multivariate analysis, resident involvement was not associated with increased rates of any aggregate or individual adverse event. There was also no association between resident involvement and risk of readmission within 30 days. Resident involvement was not associated with any difference in operative time (P = .219). Conclusion Resident involvement in shoulder arthroscopy was not associated with increased risk of adverse events, increased operative time, or readmission within 30 days. The results of this study suggest that resident involvement in shoulder arthroscopy cases is a safe method for trainees to learn these procedures.
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Affiliation(s)
- Bryce A Basques
- Midwestern Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Bryan M Saltzman
- Midwestern Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Erik N Mayer
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, USA
| | - Bernard R Bach
- Midwestern Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Anthony A Romeo
- Midwestern Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Nikhil N Verma
- Midwestern Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J Cole
- Midwestern Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Alexander E Weber
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, USA
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Complications After Arthroscopic Shoulder Surgery: A Review of the American Board of Orthopaedic Surgery Database. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2018; 2:e093. [PMID: 30680371 PMCID: PMC6336573 DOI: 10.5435/jaaosglobal-d-18-00093] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introduction: Shoulder arthroscopies are among the most frequently performed surgeries by orthopaedic surgeons. Little is known about complication rates among recently trained surgeons. The purpose of this study was to examine the type and frequency of complications of common arthroscopic shoulder procedures performed by candidates challenging the American Board of Orthopaedic Surgery: Part II, certification examination. Methods: Data were obtained from the American Board of Orthopaedic Surgery database for orthopaedic surgeons who sat for the part II examination from 2012 to 2016. In total, 27,072 procedures were reviewed. The database was queried to determine the type and frequency of complications for patients who underwent shoulder arthroscopy, including arthroscopic rotator cuff repair, labrum repair, biceps tenodesis, and bony/soft tissue débridement procedures. Complications were classified as surgical, anesthetic, or medical. Factors affecting complication rates were investigated including surgeon's fellowship training, geographic location, and patients’ age and sex. Results: Patients with surgical complications (n = 2,133; 7.9%) were more common than anesthetic (n = 263; 1.0%) or medical (n = 607; 2.2%) complications. There was a significant variation in the surgical complication rate among different arthroscopic shoulder procedures, ranging from 5.4% for labral repair to 10.3% for rotator cuff repair and biceps tenodesis. Stiffness/arthrofibrosis was the most commonly recorded surgical complication (2.2%). Surgical complication rates were lowest in the Northeast region (6.7%; P < 0.01) and in patients younger than 21 years (3.8%; P < 0.01). Women had significantly higher rate of complications than men (8.4% versus 7.6%; P = 0.02). Among anesthetic-related complications, 61.6% were related to regional nerve blocks. The overall revision surgery and readmission rates were 0.8% and 1.0%, respectively. Conclusion: The overall self-reported surgical complication rate for arthroscopic shoulder procedures was 7.9%, which is higher than the rates reported in the literature. Although the rate of anesthetic complications is low (1.0%), adverse events related to nerve blocks made up most of the overall anesthetic related complications.
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Risk Factors for Short-term Complications After Rotator Cuff Repair in the United States. Arthroscopy 2018; 34:1158-1163. [PMID: 29242096 DOI: 10.1016/j.arthro.2017.10.040] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/14/2017] [Accepted: 10/15/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To use a population-level dataset to evaluate the rate of 30-day complications after rotator cuff repair, and to evaluate the risk factors for complication and unplanned hospital readmission. METHODS We used the American College of Surgeons National Surgical Quality Improvement Program from 2011 to 2015 to identify patients who underwent rotator cuff repair and concomitant procedures using Current Procedural Terminology codes. Postoperative complications and unplanned hospital readmissions were identified. Patient demographics, medical comorbidities, and perioperative variables were used in a multivariate logistic regression model to identify the risk factors for infection, any complication, and unplanned hospital readmission. RESULTS A total of 23,741 patients were identified who underwent rotator cuff repair. Overall, 1.39% of patients experienced at least 1 complication, with 0.66% minor complications and 0.85% major complications. Unplanned readmission occurred in 1.16% of patients. Infection was the most common complication, occurring in 0.3% of patients (n = 72), and was the most common reason for return to the operating room. Open rotator cuff repair and male gender were independent risk factors for all outcomes. Increased age and numerous medical comorbidities were associated with the risk of any complication or unplanned hospital readmission. CONCLUSIONS Rotator cuff repair has a low incidence of short-term complications. Infection was the most common complication. Open repair, male gender, increased age, and medical comorbidities all significantly increased the risk of complications and hospital readmission. LEVEL OF EVIDENCE Level IV, case series.
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Goodman AD, Gil JA, Starr AM, Akelman E, Weiss APC. Thirty-Day Reoperation and/or Admission After Elective Hand Surgery in Adults: A 10-Year Review. J Hand Surg Am 2018; 43:383.e1-383.e7. [PMID: 29150192 DOI: 10.1016/j.jhsa.2017.10.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 09/05/2017] [Accepted: 10/13/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Whereas acute complications following elective hand surgery have been assumed to be rare, the incidence of 30-day unplanned reoperation and/or admission for the most common elective procedures has not been well described. Our goal was to calculate the incidence and identify the risk factors associated with these complications in a busy academic practice. METHODS Our institution's quality assurance database was examined retrospectively for unplanned reoperations and/or admissions within 30 days in adults undergoing elective procedures with 2 senior attending surgeons from February 2006 to January 2016. Each event was categorized by causative factor and charts were reviewed to establish risk factors and cultured organisms. Our billing database was examined for the concomitant procedural volume. RESULTS In our cohort of 18,081 surgeries (57.6% carpal tunnel or trigger digit releases), 27 patients had an unplanned reoperation and/or admission within 30 days (0.15% total incidence; including carpal tunnel release, 0.10%; trigger digit release, 0.09%; major wrist surgery, 0.74%) including 17 infections (0.09%). These were unevenly distributed over time after surgery with 29.6% occurring within 7 days, 59.2% in 8 to 14 days, 11.1% in 15 to 21 days, and none between 22 and 30 days. CONCLUSIONS Reoperations and/or unplanned admission within 30 days after elective hand surgery are infrequent (15 per 10,000 cases) and are most commonly related to infections (63.0%). More invasive surgeries are associated with a higher incidence than simpler procedures, and these complications are most likely to occur within 3 weeks after surgery. These data in elective patients do not cover certain clinically relevant outcomes, such as chronic pain or limited function, and may not be generalizable to all practices. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Avi D Goodman
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI.
| | - Joseph A Gil
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
| | - Adam M Starr
- Department of Orthopaedics, Brooke Army Medical Center, JBSA Fort Sam Houston, TX
| | - Edward Akelman
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
| | - Arnold-Peter C Weiss
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
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Noticewala MS, Trofa DP, Vance DD, Jobin CM, Levine WN, Ahmad CS. Elbow Arthroscopy: 30-Day Postoperative Complication Profile and Associated Risk Factors. Arthroscopy 2018; 34:414-420. [PMID: 29273253 DOI: 10.1016/j.arthro.2017.08.286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 08/18/2017] [Accepted: 08/19/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze (1) the incidence and type of complications after elbow arthroscopy, (2) the incidence of returning to the operating room (OR) after elbow arthroscopy, and (3) patient and risk factors for complications across a national surgical outcome database. METHODS Patients who underwent elbow arthroscopy from January 2005 through December 2014 were identified in the American College of Surgeons National Surgical Quality Improvement Program database by use of Current Procedural Terminology codes. Basic patient demographic data and medical comorbidities were recorded. Postoperative adverse events and a return to the OR occurring within 30 days after the index procedure were identified, and patient and procedural risk factors were investigated. RESULTS Five hundred thirty elbow arthroscopy cases were available for analysis. The aggregate rate of 30-day adverse events was 2.83%, whereas the rate of any patient having an adverse event was 1.89%. The most common adverse event was deep infection (0.57%). Univariate analyses showed that renal disease, preoperative steroid use, higher American Society of Anesthesiologists (ASA) class, and preoperative diagnosis were associated with the occurrence of an adverse event. Multivariate analyses showed that increasing ASA class, specifically ASA class 3 and class 4, was an independent predictor of a postoperative adverse event. Furthermore, 0.94% of cases required a return to the OR. Univariate analyses showed that preoperative steroid use and diagnosis of trauma were associated with a return to the OR. These findings were confirmed by multivariate analyses. CONCLUSIONS Overall, the incidence of 30-day postoperative adverse events (1.89%) and need to return to the OR (0.94%) is low. Increased ASA class is an independent risk factor for the occurrence of a postoperative adverse event; preoperative steroid use and diagnoses relating to a traumatic or inflammatory cause are predictive of the need to return to the OR. These results can assist surgeons in patient selection, preoperative optimization, and preoperative risk stratification. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Manish S Noticewala
- Center for Shoulder, Elbow, and Sports Medicine, Department of Orthopaedic Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York, U.S.A..
| | - David P Trofa
- Center for Shoulder, Elbow, and Sports Medicine, Department of Orthopaedic Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York, U.S.A
| | - Danica D Vance
- Center for Shoulder, Elbow, and Sports Medicine, Department of Orthopaedic Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York, U.S.A
| | - Charles M Jobin
- Center for Shoulder, Elbow, and Sports Medicine, Department of Orthopaedic Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York, U.S.A
| | - William N Levine
- Center for Shoulder, Elbow, and Sports Medicine, Department of Orthopaedic Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York, U.S.A
| | - Christopher S Ahmad
- Center for Shoulder, Elbow, and Sports Medicine, Department of Orthopaedic Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York, U.S.A
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Heyer JH, Kuang X, Amdur RL, Pandarinath R. Identifiable risk factors for thirty-day complications following arthroscopic rotator cuff repair. PHYSICIAN SPORTSMED 2018; 46:56-60. [PMID: 28974126 DOI: 10.1080/00913847.2018.1388732] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Shoulder arthroscopy has increased in frequency over the past decade, with rotator cuff repair comprising the majority of cases performed. Prior studies have detailed risk factors for 30-day complications and readmission rates after arthroscopic shoulder surgery using the National Surgical Quality Improvement Program (NSQIP) database, but no study has specifically looked at arthroscopic rotator cuff repair. The purpose of the study is to evaluate the risk factors for 30-day complications following arthroscopic rotator cuff repair using the NSQIP database. METHODS The NSQIP database was queried for all patients undergoing arthroscopic rotator cuff repair from 2006-2015. Demographics and thirty-day outcomes for these patients were analyzed using univariate analyses and multivariate regression analysis to determine the risk factors for complications. RESULTS 21,143 patients underwent arthroscopic rotator cuff repair, with 147 patients (0.70%) having a complication within 30-days. Univariate analysis found age >65 (p = 0.0028), male gender (p = 0.0053), elevated BMI (p = 0.0054), ASA class >2 (p < 0.0001), history of chronic obstructive pulmonary disease (p < 0.0001), hypertension (p < 0.0002), dyspnea (p < 0.0001), steroid use (p = 0.0350), and operative time >90 min (p = 0.0316) to be associated with increased risk of complications. Multivariate analysis found female sex to be protective or complication (OR 0.56, p = 0.0017), while American Society of Anesthesiology (ASA) class >2 (OR 1.51, p = 0.0335) and history of COPD (OR 2.41, p = 0.0030) and dyspnea (OR 1.89, p = 0.0359) to be risk factors for complication. The most common complication is venothromboembolic events, accounting for 36.7% of all complications. CONCLUSION Male sex, ASA class > 2, and history of COPD and dyspnea were independent risk factors for thirty-day complications following arthroscopic rotator cuff repair. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jessica H Heyer
- a George Washington University Hospital , Department of Orthopaedic Surgery , Washington , DC , USA
| | - Xiangyu Kuang
- b Department of Surgery , Medical Faculty Associates at the George Washington University , Washington , DC , USA
| | - Richard L Amdur
- b Department of Surgery , Medical Faculty Associates at the George Washington University , Washington , DC , USA
| | - Rajeev Pandarinath
- a George Washington University Hospital , Department of Orthopaedic Surgery , Washington , DC , USA
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21
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Medvedev G, Wang C, Amdur R, Neviaser R, Neviaser A. Operative Distal Humerus Fractures in Older Patients: Predictors for Early Complications Based on a National Database. HSS J 2017; 13:212-216. [PMID: 28983212 PMCID: PMC5617813 DOI: 10.1007/s11420-017-9547-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 02/03/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Open reduction internal fixation (ORIF) and total elbow arthroplasty (TEA) have both been utilized in the treatment of distal humerus fractures in patients over 65 years of age. Comparisons of early complications between these procedures have not been well described. QUESTIONS/PURPOSES The purpose of this study is to evaluate complication rates in the treatment of distal humerus fractures in elderly patients and to utilize prediction models to identify risk factors associated with postoperative complications. Additionally, to compare ORIF and TEA treatment. METHODS A retrospective case series was performed by querying the National Surgical Quality Improvement Program for both ORIF and TEA performed for distal humerus fractures in patients over the age of 65 years between 2005 and 2014. We examined both preoperative risk factors and complications within 30 days in these three groups. RESULTS The sample included 216 ORIF and 65 TEA cases. No outcomes examined differed significantly between treatment groups. The most common outcome for both groups was bleeding requiring transfusion (8%). The observed effect size for the association between procedure and the composite morbidity outcome indicated little to no association (phi = 0.004). Furthermore, no presurgery variables were found to be significantly associated with procedure type. The only predictor with a significant independent association with the composite outcome, regardless of procedure type, was ASA class 3/4. CONCLUSION Clinical complications were low no matter the type of treatment. Low preoperative hematocrit was a risk factor in both ORIF and TEA.
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Affiliation(s)
- Gleb Medvedev
- 0000 0004 1936 9510grid.253615.6Department of Orthopaedic Surgery, George Washington University, 2150 Pennsylvania Ave, NW , Washington, DC 20037 USA
| | - Charles Wang
- 0000 0001 2182 3733grid.255414.3Eastern Virginia Medical School, Norfolk, VA USA
| | - Richard Amdur
- 0000 0004 1936 9510grid.253615.6Biostatistics, George Washington University, Washington, DC USA
| | - Robert Neviaser
- 0000 0004 1936 9510grid.253615.6Department of Orthopaedic Surgery, George Washington University, 2150 Pennsylvania Ave, NW , Washington, DC 20037 USA
| | - Andrew Neviaser
- 0000 0004 1936 9510grid.253615.6Department of Orthopaedic Surgery, George Washington University, 2150 Pennsylvania Ave, NW , Washington, DC 20037 USA
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Wang D, Bluth BE, Ishmael CR, Cohen JR, Wang JC, Petrigliano FA. Early complications of acromioclavicular joint reconstruction requiring reoperation. Knee Surg Sports Traumatol Arthrosc 2017; 25:2020-2024. [PMID: 27311450 DOI: 10.1007/s00167-016-4206-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 06/08/2016] [Indexed: 01/20/2023]
Abstract
PURPOSE Prior studies have reported high complication rates with acromioclavicular joint reconstruction (ACJR). However, many of these reports have suffered from small sample sizes and inclusion of older surgical techniques. The purpose of this study was to determine the rates of early complications requiring reoperation in patients treated with ACJR. METHODS From 2007 to 2011, patients who were treated with ACJR were identified using the PearlDiver database, a large insurance database in the USA. The following reoperations were then queried from this patient cohort: irrigation and debridement within 30 days of index surgery, manipulation under anaesthesia (MUA) of the shoulder joint within 3 months of index surgery, and revision ACJR, distal clavicle excision, and removal of hardware within 6 months of index surgery. RESULTS In total, 2106 patients treated with ACJR were identified. The reoperation rates for irrigation and debridement, MUA, revision ACJR, distal clavicle excision, and removal of hardware were 2.6, 1.3, 4.2, 2.8, and 6.2 %, respectively. Patients ≥35 years of age and females more likely to undergo a reoperation after ACJR. Specifically, patients ≥35 years of age were more likely to undergo MUA and revision ACJR, while patients ≥50 years of age were more likely to undergo an irrigation and debridement. Females were more likely than males to undergo revision ACJR and distal clavicle excision. CONCLUSIONS Older patients and females were more likely to experience postoperative complications requiring reoperations, including revision ACJR, distal clavicle excision, and irrigation and debridement. By analysing a large cohort of patients across multiple centres and providers, this study provides valuable insight into the recent complication profiles of ACJR, allowing surgeons to appropriately counsel patients on the risks of these procedures. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Dean Wang
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA), 10833 Le Conte Ave, 76-143 CHS, Box 956902, Los Angeles, CA, 90095-6902, USA.
| | - Benjamin E Bluth
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA), 10833 Le Conte Ave, 76-143 CHS, Box 956902, Los Angeles, CA, 90095-6902, USA
| | - Chad R Ishmael
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA), 10833 Le Conte Ave, 76-143 CHS, Box 956902, Los Angeles, CA, 90095-6902, USA
| | - Jeremiah R Cohen
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA), 10833 Le Conte Ave, 76-143 CHS, Box 956902, Los Angeles, CA, 90095-6902, USA
| | - Jeffrey C Wang
- Orthopaedic Spine Service, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Frank A Petrigliano
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA), 10833 Le Conte Ave, 76-143 CHS, Box 956902, Los Angeles, CA, 90095-6902, USA
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Choy W, Barrington N, Garcia RM, Kim RB, Rodriguez H, Lam S, Dahdaleh N, Smith ZA. Risk Factors for Medical and Surgical Complications Following Single-Level ALIF. Global Spine J 2017; 7:141-147. [PMID: 28507883 PMCID: PMC5415155 DOI: 10.1177/2192568217694009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The objective of the study was to determine rates of medical and surgical postoperative complications following anterior lumbar interbody fusion (ALIF) along with their associated predictors. METHODS Using the American College of Surgeons National Surgical Quality Improvement database, patients who underwent single-level ALIF surgery from 2006 to 2013 were identified. The 30-day rate of postoperative medical and surgical complications along with associated risk factors were evaluated by multivariable logistic regression. RESULTS In total, 1474 patients were included in the analysis. The overall rate of complications was 14.5%. The medical complication rate was 12.7%, while the surgical complication rate was 2.8%. Predictors of surgical complications were diabetes (odds ratio [OR] = 2.79, 95% CI = 1.20-6.01, P = .009), corticosteroid dependence (OR = 4.94, 95% CI = 1.73-14.08, P = .003), and preoperative transfusion of >4 units (OR = 7.12, 95% CI = 1.43-35.37, P = .016). Predictors of medical complications were longer operative times (OR = 4.25, 95% CI = 2.90-6.24, P < .001), preoperative anemia (OR = 2.29, 95% CI = 1.50-3.50, P < .001), >10% weight loss prior to surgery (OR = 6.79, 95% CI = 1.01-45.93, P = .049), and more severe American Society of Anesthesiologists classification (OR = 2.18, 95% CI = 1.54-3.11, P < .001). CONCLUSIONS The present study determines postoperative medical and surgical complications among patients undergoing ALIF. The risk factors elucidated in this study indicate that clinical practices to curtail complications should be targeted toward patients with preoperative anemia, weight loss, corticosteroid dependence, and toward those at risk for perioperative transfusions.
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Affiliation(s)
| | - Nikki Barrington
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | | | - Robert B. Kim
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | | | - Sandi Lam
- Baylor College of Medicine, Houston, TX, USA,Texas Children’s Hospital, Houston, TX, USA
| | | | - Zachary A. Smith
- Northwestern University, Chicago, IL, USA,Zachary A. Smith, Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, 676 N St Clair Street, Suite 2210, Chicago, IL 60611, USA.
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24
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Cancienne JM, Burrus MT, Diduch DR, Werner BC. High altitude is an independent risk factor for venous thromboembolism following arthroscopic rotator cuff repair: a matched case-control study in Medicare patients. J Shoulder Elbow Surg 2017; 26:7-13. [PMID: 27528541 DOI: 10.1016/j.jse.2016.06.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/01/2016] [Accepted: 06/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although the risk of venous thromboembolism (VTE) following elective shoulder arthroscopy is low, the large volume of procedures performed each year yields a significant annual burden of patients with thromboembolic complications. The purpose of this study was to evaluate the association of high procedural altitude with the incidence of postoperative VTE following arthroscopic rotator cuff repair. METHODS A Medicare database was queried for all patients undergoing arthroscopic rotator cuff repair from 2005 to 2012. All patients with procedures performed at an altitude of 4000 feet or higher were grouped into the "high-altitude" study cohort. Patients with procedures performed at an altitude of 100 feet or lower were then matched to patients in the high-altitude cohort on the basis of age, gender, and medical comorbidities. The rate of VTE was then assessed for both the high-altitude and matched low-altitude cohorts within 90 days postoperatively. RESULTS The rates of combined VTE (odds ratio [OR], 2.6; P < .0001), pulmonary embolism (OR, 4.3; P < .0001), and lower extremity deep venous thrombosis within 90 days (OR, 2.2; P = .029) were all significantly higher in patients with procedures performed at high altitude compared with matched patients with the same procedures performed at low altitude. CONCLUSIONS Procedural altitude >4000 feet is associated with significantly increased rates of postoperative VTE, including deep venous thrombosis and pulmonary embolism, compared with age-, gender-, and comorbidity-matched patients undergoing the same procedures at altitudes <100 feet.
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Affiliation(s)
- Jourdan M Cancienne
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - M Tyrrell Burrus
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - David R Diduch
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA.
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