1
|
Nardelli P, Giesinger J, Liebensteiner M, Pagenstert G, Neururer S, Leitner H, Dammerer D, van Rooij F, Saffarini M. Moonlight surgery: no influence of moon phase or Friday 13th on outcomes of total knee arthroplasty. Arch Orthop Trauma Surg 2023; 143:6169-6175. [PMID: 37306775 DOI: 10.1007/s00402-023-04919-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 05/21/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The purpose of the present study was to investigate associations between revision-free survival and functional scores of total knee arthroplasty (TKA) and moon phase on the day of surgery, as well as operations performed on a Friday 13th. PARTICIPANTS The data of all patients that received TKA between 2003 and 2019 were extracted from the Tyrol arthroplasty registry. Patients that had undergone previous total or partial knee arthroplasty as well as patients that had missing pre- or post-operative WOMAC were excluded. Patients were allocated to one of the following four groups according to moon phase on the day of surgery: new, waxing, full and waning. Patients operated on a Friday 13th were also identified and compared to patients operated on any other days/dates. A total of 5923 patients met the inclusion criteria, with mean age of 69 ± 9 years, and comprising 62% women. RESULTS There were no significant differences in revision-free survival among the four moon phase groups (p = 0.479), and no significant differences in preoperative and postoperative total WOMAC (p = 0.260, p = 0.122), There were no significant differences in revision-free survival patients operated on Friday 13th vs. other days/dates (p = 0.440). The preoperative total WOMAC was significantly worse for patients operated on a Friday 13th (p = 0.013), which was observed in the pain (p = 0.032) and function (p = 0.010) subscales. There were no significant differences in postoperative total WOMAC at 1 year follow-up (p = 0.122). CONCLUSIONS Neither moon phase on the day of surgery nor Friday 13th were associated with revision-free survival or clinical scores of TKA. Patients operated on a Friday 13th had significantly worse preoperative total WOMAC but similar postoperative total WOMAC at 1-year follow-up. These findings could help reassure patients that TKA renders consistent outcomes regardless of the preoperative pain or function, and in spite of bad omens or moon phases.
Collapse
Affiliation(s)
- Paul Nardelli
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Giesinger
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Geert Pagenstert
- Clarahof Clinic of Orthopaedic Surgery, Merian-Iselin-Hospital Swiss Olympic Medical Center, Basel, Switzerland
| | - Sabrina Neururer
- Institute for Clinical Epidemiology, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Hermann Leitner
- Institute for Clinical Epidemiology, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Dietmar Dammerer
- Department of Orthopaedics and Traumatology, University Hospital Krems, Krems, Austria
| | - Floris van Rooij
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland
- Clinique Trenel, Sainte Colombe, France
| | - Mo Saffarini
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland.
- Clinique Trenel, Sainte Colombe, France.
| |
Collapse
|
2
|
Diaz-Castrillon CE, Serna-Gallegos D, Arnaoutakis G, Grimm J, Szeto WY, Chu D, Sezer A, Sultan I. Volume-failure-to-rescue relationship in acute type A aortic dissections: An analysis of The Society of Thoracic Surgeons Database. J Thorac Cardiovasc Surg 2023:S0022-5223(23)00748-1. [PMID: 37657715 DOI: 10.1016/j.jtcvs.2023.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE To determine the relationship between volume of cases and failure-to-rescue (FTR) rate after surgery for acute type A aortic dissection (ATAAD) across the United States. METHODS The Society of Thoracic Surgeons adult cardiac surgery database was used to review outcomes of surgery after ATAAD between June 2017 and December 2021. Mixed-effect models and restricted cubic splines were used to determine the risk-adjusted relationships between ATAAD average volume and FTR rate. FTR calculation was based on deaths associated with the following complications: venous thromboembolism/deep venous thrombosis, stroke, renal failure, mechanical ventilation >48 hours, sepsis, gastrointestinal complications, cardiopulmonary resuscitation, and unplanned reoperation. RESULTS In total, 18,192 patients underwent surgery for ATAAD in 832 centers. The included hospitals' median volume was 2.2 cases/year (interquartile range [IQR], 0.9-5.8). Quartiles' distribution was 615 centers in the first (1.3 cases/year, IQR, 0.4-2.9); 123 centers in the second (8 cases/year, IQR, 6.7-10.2); 66 centers in the third (15.6 cases/year, IQR, 14.2-18); and 28 centers in the fourth quartile (29.3 cases/year, IQR, 28.8-46.0). Fourth-quartile hospitals performed more extensive procedures. Overall complication, mortality, and FTR rates were 52.6%, 14.2%, and 21.7%, respectively. Risk-adjusted analysis demonstrated increased odds of FTR when the average volume was fewer than 10 cases per year. CONCLUSIONS Although high-volume centers performed more complex procedures than low-volume centers, their operative mortality was lower, perhaps reflecting their ability to rescue patients and mitigate complications. An average of fewer than 10 cases per year at an institution is associated with increased odds of failure to rescue patients after ATAAD repair.
Collapse
Affiliation(s)
| | - Derek Serna-Gallegos
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - George Arnaoutakis
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin, Austin, Tex
| | - Joshua Grimm
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin, Austin, Tex
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, University of Pennsylvania, Pittsburgh, Pa
| | - Danny Chu
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Ahmet Sezer
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
| |
Collapse
|
3
|
Aortic dissection: global epidemiology. CARDIOLOGY PLUS 2022. [DOI: 10.1097/cp9.0000000000000028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
|
4
|
Aranda-Michel E, Bianco V, Yousef S, Brown J, Dai Y, Serna-Gallegos D, Hoskoppal A, Sultan I. National trends in thoracic aortic aneurysms and dissections in patients with Marfans and Ehlers Danlos syndrome. J Card Surg 2022; 37:3313-3321. [PMID: 35979682 DOI: 10.1111/jocs.16853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/20/2022] [Accepted: 07/11/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Connective tissue disorders predispose patients to earlier aortic dissections and aneurysms. However, there is limited large cohort data given its low incidence. METHODS The National Inpatient Sample was searched for all adults with Marfans (MFS) and Ehlers Danlos (EDS) disease between 2010 and 2017. ICD codes were used to select those with a type A aortic dissection or aneurysm. RESULTS There was a total of 19,567 cases, giving the estimated incidence of MFS and EDS of 18 and 22.4 per 100k people, respectively. After inclusion criteria, there were 2553 MF and 180 EDS patients. There was no statistical difference in mortality between the MFS and EDS cohorts (4.6% vs. 2.8%, p = .26). EDS patients were more likely to undergo a TEVAR procedure (2.8% vs. 1.0%, p = .03). MF patients were more likely to have a complication of acute kidney injury (p = .02). EDS patients were more likely older (50 vs. 42, p < .001) and female (47% vs. 33%, p < .001). MFS patients were more likely to have a type A aortic dissection (44% vs. 31%, p < .001). The majority (89%) of patients were treated at urban teaching hospitals. On univariable logistic regression, aortic dissection was a predictor for mortality (odds ratio 7.31, p < .001). The type of connective tissue disease was not a significant predictor. CONCLUSIONS National level estimates show low mortality for patients with MF or ED presenting to the hospital with aortic dissection or aneurysm. The differences in age and gender can guide surveillance for these patient populations, leading to more elective admissions and reduced hospital mortality.
Collapse
Affiliation(s)
- Edgar Aranda-Michel
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Valentino Bianco
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sarah Yousef
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James Brown
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yancheng Dai
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Derek Serna-Gallegos
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Arvind Hoskoppal
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
5
|
Naik A, Houser SL, Moawad CM, Iyer RK, Arnold PM. Noniatrogenic spinal cord ischemia: A patient level meta-analysis of 125 case reports and series. Surg Neurol Int 2022; 13:228. [PMID: 35855116 PMCID: PMC9282799 DOI: 10.25259/sni_1252_2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/31/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Guidelines are needed to manage spinal cord infarctions. Here, we evaluated the incidence of noniatrogenic spinal ischemia, focusing on the spinal levels involved, and the relative efficacy of different management strategies. Methods: We performed a meta-analysis of 147 patients who sustained noniatrogenic spinal cord ischemia within the past 10 years. The most common causes of injury were idiopathic (i.e., 47% medical/surgery-related) followed by systemic/chronic conditions (23.6%) and aortic vascular pathology (20%). Postdiagnostic treatment options included rehabilitation in 53.7% of patients, while steroids (35.37%), antiplatelets aggregates (30.61%), and anticoagulation (18.37%) were also used. Results: Traumatic causes of spinal cord ischemia were associated with worse outcomes, while those without a clear diagnosis despite extensive work-up had better results. At discharge, patients managed with cerebrospinal fluid (CSF) drainage had significant improvement (P = 0.04), while other therapies were not effective. Notably, ischemia mostly occurring between the T4 and T7 levels and was associated with the worst outcomes. In this thoracic “watershed” region, thoracic cord ischemia was most likely attributed to an increased susceptibility toto cord under-perfusion in this region (P < 0.05). Conclusion: This meta-analysis revealed a variety of etiologies for noniatrogenic typically T4-T7 spinal cord ischemia. Several different treatment strategies may be utilized in this patient population, including CSF drainage, blood pressure elevation, corticosteroids, antiplatelets/anticoagulants/thrombolytics, mannitol, naloxone, surgical revascularization, hyperbaric oxygen, and systemic hypothermia.
Collapse
Affiliation(s)
- Anant Naik
- Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign,
| | - Samantha L. Houser
- Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign,
| | - Christina M. Moawad
- Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign,
| | - Ravishankar K. Iyer
- Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign,
| | - Paul M. Arnold
- Department of Neurosurgery, Carle Illinois College of Medicine, Urbana, Illinois, United States
| |
Collapse
|
6
|
Nazir S, Ariss RW, Minhas AMK, Issa R, Michos ED, Birnbaum Y, Moukarbel GV, Ramanathan PK, Jneid H. Demographic and Regional Trends of Mortality in Patients With Aortic Dissection in the United States, 1999 to 2019. J Am Heart Assoc 2022; 11:e024533. [PMID: 35301872 PMCID: PMC9075427 DOI: 10.1161/jaha.121.024533] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Aortic dissection (AoD) is associated with high morbidity and mortality. However, the burden of AoD mortality is not well characterized, and contemporary data and mortality trends in different demographic and geographic subgroups have not been described. Methods and Results Trends in AoD mortality were assessed using a cross‐sectional analysis of the Centers for Disease Control and Prevention Wide‐Ranging Online Data for Epidemiologic Research database. Crude and age‐adjusted mortality rates (AAMR) per 1 million people with associated annual percent changes were determined. Joinpoint regression was used to assess trends in the overall sample and different demographic (sex, race and ethnicity, age) and geographic subgroups. Between 1999 and 2019, a total of 86 855 AoD deaths occurred within the United States. In the overall population, AAMR was 21.1 per 1 million in 1999 and 21.3 in 2019. After an initial decline in mortality, AAMR increased from 2012 to 2019, with an associated annual change of 2.5% (95% CI, 1.8–3.3). Men, older adults (aged ≥85 years), and non‐Hispanic Black or African American individuals had higher mortality rates than women, younger individuals, and other racial and ethnic individuals, respectively. Despite lower AAMRs throughout the study period, women experienced greater increases in AAMR from 2012 to 2019 compared with men. Similarly, non‐Hispanic Black or African American individuals had a pronounced increase in AAMR from 2012 to 2019. Conclusions Despite an initial decline in AoD mortality, the mortality rate has been increasing from 2012 to 2019, with pronounced increases among women and non‐Hispanic Black or African American individuals.
Collapse
Affiliation(s)
- Salik Nazir
- Division of Cardiovascular Medicine University of Toledo Medical Center Toledo OH.,Section of Cardiology ProMedica Toledo Hospital Toledo OH
| | - Robert W Ariss
- Division of Cardiovascular Medicine University of Toledo Medical Center Toledo OH.,Section of Cardiology ProMedica Toledo Hospital Toledo OH
| | | | - Rochell Issa
- Division of Cardiovascular Medicine University of Toledo Medical Center Toledo OH.,Section of Cardiology ProMedica Toledo Hospital Toledo OH
| | - Erin D Michos
- Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
| | | | - George V Moukarbel
- Division of Cardiovascular Medicine University of Toledo Medical Center Toledo OH
| | | | - Hani Jneid
- Section of Cardiology Baylor College of Medicine Houston TX
| |
Collapse
|