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Simske NM, Rivera T, Ren BO, Breslin MA, Furdock R, Vallier HA. Impact of novel psychosocial programming on readmission and recidivism rates among patients with violence-related trauma. Arch Orthop Trauma Surg 2023; 143:7043-7052. [PMID: 37558824 DOI: 10.1007/s00402-023-05019-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/25/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION The Victims of Crime Advocacy and Recovery Program (VOCARP) provides advocacy, mental health resources, and educational materials. This study will report complications, readmissions, and recidivism among crime victims, and who used or did not use victim services. MATERIALS AND METHODS Patients engaged with programming from 3/1/17 until 12/31/18 were included. Control groups were patients injured by violent trauma without VOCARP use (N = 212) and patients injured by unintentional injuries (N = 201). Readmissions, complications, reoperations, and trauma recidivism were reported. RESULTS 1019 patients (83%) used VOCARP. VOCARP users were less often male (56% vs. 71%), less commonly married (12% vs. 41%), and had fewer gunshot wounds (GSWs, 26% vs. 37%) and sexual assaults (4.1% vs. 8%), all p < 0.05. Of all 1,423 patients, 6.6% had a readmission and 7.4% developed a complication. VOCARP patients had fewer complications (4.5% vs. 13.7%), infections (2% vs. 9%), wound healing problems (1% vs. 3.3%), and deep vein thromboses (0.3% vs. 1.9%), all p < 0.05, but no differences in unplanned operations (4.5%). GSW victims had the most complications, readmissions, and unplanned surgeries. Prior trauma recidivism was frequent among all groups, with crime victim patients having 40% prior violence-related injury (vs 9.0% control, p < 0.0001). Trauma recidivism following VOCARP use occurred in 8.5% (vs 5.7% for non-users, p = 0.16). CONCLUSION Crime victims differ from other trauma patients, more often with younger age, single marital status, and unemployment at baseline. Complications were lower for VOCARP patients. GSW patients had the most complications, readmissions, and unplanned secondary procedures, representing a population for future attention.
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Affiliation(s)
| | - Trenton Rivera
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Bryan O Ren
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Mary A Breslin
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Ryan Furdock
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Heather A Vallier
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, USA.
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Culbert AA, Ren BO, Maheshwer B, Curtis A, Ajayakumar J, Gilmore A, Hardesty C, Mistovich RJ, Son-Hing J, Liu RW, Glotzbecker MP. Disparities in Pediatric Orthopedic Surgery Care During the COVID-19 Pandemic Pre-vaccine and Post-Vaccine Availability. J Pediatr Orthop 2023; 43:529-535. [PMID: 37442779 PMCID: PMC10627400 DOI: 10.1097/bpo.0000000000002469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
BACKGROUND The COVID-19 pandemic has led to significant disruptions in medical care, resulting in an estimated 40% of US adults avoiding care. However, the return to baseline health care utilization following COVID-19 restrictions within the pediatric orthopedic population remains unexplored. We sought to analyze the visit volume and demographics of pediatric orthopedic patients at 3 timepoints: prepandemic (2019), pandemic (2020), and pandemic post-vaccine availability (2021), to determine the impact of COVID-19 restrictions on our single-center, multisite institution. METHODS We performed a retrospective cohort study of 6318 patients seeking treatment at our institution from May through August in 2019, 2020, and 2021. Patient age, sex, address, encounter date, and ICD-10 codes were obtained. Diagnoses were classified into fractures and dislocations, non-fracture-related trauma, sports, elective, and other categories. Geospatial analysis comparing incidence and geospatial distribution of diagnoses across the time periods was performed and compared with the Centers for Disease Control (CDC) social vulnerability index (SVI). RESULTS The total number of pediatric orthopedic visits decreased by 22.2% during the pandemic ( P <0.001) and remained 11.6% lower post-vaccine availability compared with prepandemic numbers ( P <0.001). There was no significant difference in age ( P =0.097) or sex ( P =0.248) of the patients across all 3 timepoints; however, patients seen during the pandemic were more often White race (67.7% vs. 59.3%, P <0.001). Post-vaccine availability, trauma visits increased by 18.2% ( P <0.001) and total fractures remained 13.4% lower than prepandemic volume ( P <0.001). Sports volume decreased during the pandemic but returned to prepandemic volume in the post-vaccine availability period ( P =0.298). Elective visits did not recover to prepandemic volume and remained 13.0% lower compared with baseline ( P <0.001). Geospatial analysis of patient distribution illustrated neighborhood trends in access to care during the COVID-19 pandemic, with fewer patients from high SVI and low socioeconomic status neighborhoods seeking fracture care during the pandemic than prepandemic. Post-vaccine availability, fracture population distribution resembled prepandemic levels, suggesting a return to baseline health care utilization. CONCLUSION Pediatric orthopedic surgery visit volume broadly decreased during the COVID-19 pandemic and did not return to prepandemic levels. All categories increased in the post-vaccine availability time point except elective visits. Geospatial analysis revealed that neighborhoods with a high social vulnerability index (SVI) were associated with decreased fracture visits during the pandemic, whereas low SVI neighborhoods did not experience as much of a decline. Future research is needed to study these neighborhood trends and more completely characterize factors preventing equitable access to care in the pediatric orthopedic population. LEVEL OF EVIDENCE Retrospective Study, Level III.
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Affiliation(s)
- August A. Culbert
- Cleveland Clinic Lerner College of Medicine
- Division of Pediatric Orthopedic Surgery, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH
| | - Bryan O. Ren
- Division of Pediatric Orthopedic Surgery, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI
| | - Bhargavi Maheshwer
- Division of Pediatric Orthopedic Surgery, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH
| | - Andrew Curtis
- Department of Population and Quantitative Health Sciences, Case Western Reserve University
| | | | - Allison Gilmore
- Division of Pediatric Orthopedic Surgery, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH
| | - Christina Hardesty
- Division of Pediatric Orthopedic Surgery, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH
| | - R. Justin Mistovich
- Division of Pediatric Orthopedic Surgery, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH
| | - Jochen Son-Hing
- Division of Pediatric Orthopedic Surgery, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH
| | - Raymond W. Liu
- Division of Pediatric Orthopedic Surgery, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH
| | - Michael P. Glotzbecker
- Division of Pediatric Orthopedic Surgery, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH
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Folkman MJ, Ren BO, Maheshwer B, Klyce WB, Mistovich RJ. Seven-year Outcomes of Adolescent Forearm Fractures Treated With Plate Fixation. J Pediatr Orthop 2023; 43:e446-e450. [PMID: 37072917 DOI: 10.1097/bpo.0000000000002412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND Pediatric forearm fractures are common injuries and can sometimes require surgical treatment. Few studies have evaluated the long-term outcomes of pediatric forearm fracture plating. We evaluated long-term functional outcomes and satisfaction in children with forearm fractures treated with plate fixation. METHODS We performed a single-institution case series at a pediatric level 1 trauma center. Inclusion criteria were: patients with radius and/or ulna diaphyseal fractures, index surgery at 18 years of age or younger, plate fixation, and a minimum of 2 years follow-up. We surveyed patients with the QuickDASH outcome measure and supplemented this with functional outcomes and satisfaction questions. Demographics and surgery characteristics were obtained from the electronic medical record. RESULTS A total of 41 patients met the eligibility criteria, of whom 17 completed the survey with a mean follow-up of 7.2 ± 1.4 years. The mean age at index surgery was 13.1 ± 3.6 years (range, 4 to 17), with 65% males. All patients reported at least one symptom, with aching (41%) and pain (35%) occurring most frequently. There were 2 complications (12%), including one infection and one compartment syndrome treated with fasciotomy. Hardware removal occurred in 29% of patients. There were no refractures. The mean QuickDASH score was 7.7 ± 11.9, with an occupation module score of 1.6 ± 3.9 and a sports/performing arts module score of 12.0 ± 19.7. The mean surgery satisfaction was 92% and scar satisfaction was 75%. All patients returned to prior activities and 88% reported a return to their preoperative baseline level of function. CONCLUSIONS Plate fixation for pediatric forearm fractures achieves osseous union but not without the potential for long-term sequelae. All patients reported residual symptoms 7 years later. Scar satisfaction and return to baseline function were imperfect. Patient education for long-term outcomes of surgery is essential, especially in the transition to adulthood. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Matthew J Folkman
- Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children's Hospital, Case Western Reserve University
- The University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Bryan O Ren
- Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children's Hospital, Case Western Reserve University
- Department of Orthopaedic Surgery, University Hospitals Case Medical Center
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
| | - Bhargavi Maheshwer
- Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children's Hospital, Case Western Reserve University
- Department of Orthopaedic Surgery, University Hospitals Case Medical Center
| | - Walter B Klyce
- Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children's Hospital, Case Western Reserve University
- Department of Orthopaedic Surgery, University Hospitals Case Medical Center
| | - R Justin Mistovich
- Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children's Hospital, Case Western Reserve University
- Department of Orthopaedic Surgery, University Hospitals Case Medical Center
- Division of Orthopaedic Surgery, MetroHealth System, Cleveland
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Alejo AL, Rascoe A, Kim CY, Ren BO, Hoffa MT, Heimke IM, Vallier HA. Prolonged Time to Brake Following Lower Extremity Injuries. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202304000-00002. [PMID: 37026753 PMCID: PMC10082306 DOI: 10.5435/jaaosglobal-d-23-00018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 01/30/2023] [Indexed: 04/08/2023]
Abstract
INTRODUCTION No guidelines exist for recommending return to driving. This study will examine time to brake (TTB) after lower extremity injuries versus in uninjured people. The potential effect of various types of lower extremity injuries on TTB will be measured. METHODS Patients with injuries to the pelvis, hip, femur, knee, tibia, ankle, and foot underwent testing using a driving simulator to assess TTB. Comparison was with a control group of uninjured people. RESULTS Two-hundred thirty-two patients with lower extremity injuries participated. The majority were in the tibia and ankle regions (47%). Mean TTB for control subjects was 0.74 seconds, compared with 0.83 for injured patients, noting a 0.09-second difference (P = 0.017). Left-sided injuries averaged TTB of 0.80 seconds, right-sided injuries averaged TTB of 0.86 seconds, and bilateral injuries averaged TTB of 0.83 seconds, all prolonged versus control subjects. The longest TTB was exhibited after ankle and foot injuries (0.89 seconds) while the shortest was after tibial shaft fractures (0.76 seconds). DISCUSSION Any lower extremity injury caused a prolonged TTB compared with control patients. Left, right, and bilateral injuries all had longer TTB. Ankle and foot injuries experienced the longest TTB. Additional investigation is warranted to develop safe guidelines for return to driving.
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Affiliation(s)
- Andrew L Alejo
- From Northeast Ohio Medical University, Rootstown, OH (Mr. Alejo); School of Medicine, Case Western Reserve University, Cleveland, OH (Dr. Rascoe, Dr. Kim, Dr. Ren, Mr. Hoffa, and Dr. Vallier); and Ohio University College of Medicine, Cleveland, OH (Ms. Heimke)
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McMellen CJ, Ina JG, Ren BO, Hanna P, Gilmore A. Modified Grammont Soft-Tissue Distal Patellar Realignment and Medial Patellofemoral Ligament Reconstruction for Patellofemoral Instability in Pediatric Patients. Arthrosc Tech 2022; 11:e2255-e2263. [PMID: 36632408 PMCID: PMC9827068 DOI: 10.1016/j.eats.2022.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/17/2022] [Indexed: 11/19/2022] Open
Abstract
Patellar dislocation is a relatively common pediatric injury, which often results in recurrent patellofemoral instability. An increased tibial tubercle-trochlear groove distance predisposes to patellofemoral instability and can be corrected with a distal realignment procedure. Soft-tissue distal realignment procedures must be used in the pediatric population to avoid the risks of premature physeal closure associated with tibial tubercle osteotomies. Several soft-tissue distal realignment procedures have been described, with no consensus as to the optimal technique. When combined with medial patellofemoral ligament reconstruction, distal realignment procedures can restore patellofemoral stability through the entire flexion arc. This article describes a modification of the Grammont distal patellar realignment procedure in conjunction with medial patellofemoral ligament reconstruction for the management of pediatric patellofemoral instability.
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Affiliation(s)
- Christopher J. McMellen
- Address correspondence to Christopher J. McMellen, M.D., University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Hanna House 5043, Cleveland, OH 44016, USA
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Ren BO, Khambete P, Rasendran C, O'Donnell JA, Ahn NU. Quantifying the Economic Impact of Depression for Spine Patients in the United States. Clin Spine Surg 2022; 35:E374-E379. [PMID: 34183545 DOI: 10.1097/bsd.0000000000001220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 06/01/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective cross-sectional analysis. OBJECTIVE The objective of this study was to estimate the incremental health care costs of depression in patients with spine pathology and offer insight into the drivers behind the increased cost burden. SUMMARY OF BACKGROUND DATA Low back pain is estimated to cost over $100 billion per year in the United States. Depression has been shown to negatively impact clinical outcomes in patients with low back pain and those undergoing spine surgery. MATERIALS AND METHODS Data was collected from the Medical Expenditure Panel Survey from 2007 to 2015. Spine patients were identified and stratified based on concurrent depression International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Health care utilization and expenditures were analyzed between patients with and without depression using a multivariate 2-part logistic regression with adjustments for sociodemographic characteristics and Charlson Comorbidity Index. RESULTS A total of 37,094 patients over 18 years old with a spine condition were included (mean expenditure: $7829±241.67). Of these patients, 7986 had depression (mean expenditure: $11,455.41±651.25) and 29,108 did not have depression (mean expenditure: $6837.89±244.51). The cost of care for spine patients with depression was 1.42 times higher (95% confidence interval, 1.34-1.52; P<0.001) than patients without depression. The incremental expenditure of spine patients with depression was $3388.22 (95% confidence interval, 2906.60-3918.96; P<0.001). Comorbid depression was associated with greater inpatient, outpatient, emergency room, home health, and prescription medication utilization and expenditures compared with the nondepressed cohort. CONCLUSIONS Spine patients with depression had significantly increased incremental economic cost of nearly $3500 more annually than those without depression. When extrapolated nationally, this translates to an additional $27.5 billion annually in incremental expenditures that can be attributed directly to depression among spine patients, which equates to roughly 10% of the total estimated spending on depression nationally. Strategies focused on optimizing the treatment of depression have the potential for dramatically reducing health care costs in spine surgery patients.
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Affiliation(s)
- Bryan O Ren
- Department of Orthopaedics, University Hospitals Cleveland Medical Center
- Case Western Reserve, School of Medicine, University, Cleveland, OH
| | - Pranav Khambete
- Department of Orthopaedics, University Hospitals Cleveland Medical Center
- Case Western Reserve, School of Medicine, University, Cleveland, OH
| | - Chandruganesh Rasendran
- Department of Orthopaedics, University Hospitals Cleveland Medical Center
- Case Western Reserve, School of Medicine, University, Cleveland, OH
| | - Jeffrey A O'Donnell
- Department of Orthopaedic Surgery, Duke, School of Medicine, University, Durham, NC
| | - Nicholas U Ahn
- Department of Orthopaedics, University Hospitals Cleveland Medical Center
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Ren BO, Teplensky JR, Abola MV, Komarovsky MB, Cooperman DR, Bauer JM, Liu RW. Interfacet distance at L4 is increased in spines with high pelvic incidence. Clin Anat 2022; 35:1039-1043. [PMID: 35333410 DOI: 10.1002/ca.23859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/18/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Pelvic incidence (PI) is an angular measurement linked to spinal pathologies. There is an increasing distance between facet joints moving caudally down the sagittal plane of the spine. We defined pedicle divergence (PD) as the ratio of interfacet distance (IFD) between adjacent levels. This study aimed to evaluate the relationship between PI and PD. MATERIALS AND METHODS Two hundred and thirty specimens were obtained from the Hamann-Todd Osteological Collection. Specimens were catalogued for age, sex, race, PI, PD, and lumbar facet angle. Multivariate linear regression analysis was performed to determine the relationship between variables. IRB approval was not required. RESULTS Average age at death was 57.0 years ± 6.2 years. There were 211 (92%) male specimens and 176 (77%) were white. Average PI was 47.1 ± 10.5°. For pedicle divergence between L3/L4, there was a relationship with PI (β = -0.18, P = 0.008). For pedicle divergence between L4/L5, there was an opposite relationship with PI (β = 0.21, P = 0.003). Regression analyses of the interfacet to body ratio at each level found an association with PI only at L4 (P = 0.008). CONCLUSIONS This study demonstrated that pelvic incidence has a significant association with interfacet distance in the lower lumbar spine. Increasing pelvic incidence was associated with increased PD between L3/L4 and decreased PD between L4/L5. These results further support the close relationship between pelvic morphology and the lower lumbar spine, and suggest that L4 may have an important role in compensating for aberrant pelvic incidence. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Bryan O Ren
- University Hospitals Rainbow Babies & Children's Hospital Division of Pediatric Orthopedics, 11100 Euclid Avenue, Cleveland, OH
| | - Jason R Teplensky
- University Hospitals Rainbow Babies & Children's Hospital Division of Pediatric Orthopedics, 11100 Euclid Avenue, Cleveland, OH
| | - Matthew V Abola
- New York University Langone Orthopedic Hospital Department of Orthopedic Surgery, 301 East 17th Street, New York, NY
| | - Michael B Komarovsky
- University Hospitals Rainbow Babies & Children's Hospital Division of Pediatric Orthopedics, 11100 Euclid Avenue, Cleveland, OH
| | - Daniel R Cooperman
- Yale School of Medicine Department of Orthopaedics and Rehabilitation, 800 Howard Avenue, New Haven, CT
| | - Jennifer M Bauer
- Seattle Children's Hospital Department of Orthopedics and Sports Medicine, 4800 Sand Point Way NE, Seattle, WA
| | - Raymond W Liu
- University Hospitals Rainbow Babies & Children's Hospital Division of Pediatric Orthopedics, 11100 Euclid Avenue, Cleveland, OH
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Simske NM, Rivera T, Ren BO, Benedick A, Simpson M, Kalina M, Hendrickson SB, Vallier HA. Implementation of programming for survivors of violence-related trauma at a level 1 trauma center. Trauma Surg Acute Care Open 2021; 6:e000739. [PMID: 34693023 PMCID: PMC8499348 DOI: 10.1136/tsaco-2021-000739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/29/2021] [Indexed: 11/18/2022] Open
Abstract
Background Prior investigation of violence intervention programs has been limited. This study will describe resources offered by Victims of Crime Advocacy and Recovery Program (VOCARP), their utilization, and effect on recidivism. Methods VOCARP was established in 2017 at our center, and all patients who engaged with programming (n=1019) were prospectively recorded. Patients are offered services in the emergency department, on inpatient floors and at outpatient clinic visits. Two control groups (patients sustaining violent injuries without VOCARP use (n=212) and patients with non-violent trauma (n=201)) were similarly aggregated. Results During 22 months, 96% of patients accepted education materials, 31% received financial compensation, 27% requested referrals, and 22% had crisis interventions. All other resources were used by <20% of patients. Patients who used VOCARP resources were substantially different from those who declined services; they were less often male (56% vs. 71%), more often single (79% vs. 51%), had greater unemployment (63% vs. 51%) and were less frequently shot (gunshot wound: 26% vs. 37%), all p<0.05. Overall recidivism rate was 9.4%, with no difference between groups. Use of mental health services was linked to lower recidivism rates (4.4% vs. 11.7%, p=0.016). While sexual assault survivors who used VOCARP resources had lower associated recidivism (2.4% vs. 12%, p=0.14), this was not statistically significant. Discussion This represents the largest violence intervention cohort reported to date to our knowledge. Despite substantial engagement, efficacy in terms of lower recidivism appears limited to specific subgroups or resource utilization. Level of evidence Level II. Therapeutic.
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Affiliation(s)
| | - Trenton Rivera
- Orthopedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | - Bryan O Ren
- Orthopedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | - Alex Benedick
- Orthopedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | - Megen Simpson
- Orthopedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | - Mark Kalina
- Orthopedic Surgery, MetroHealth System, Cleveland, Ohio, USA
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Ren BO, O'Donnell JA, Anderson JT, Haas AR, Percy R, Woods ST, Ahn UM, Ahn NU. Time to Surgery Affects Return to Work Rates for Workers' Compensation Patients With Single-Level Lumbar Disk Herniation. Orthopedics 2021; 44:e43-e49. [PMID: 33284984 DOI: 10.3928/01477447-20201202-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/13/2019] [Indexed: 02/03/2023]
Abstract
The optimal timing of lumbar diskectomy in patients with lumbar disk herniation and radiculopathy has not been studied in the workers' compensation (WC) population. A total of 10,592 patients received lost-work compensation from the Ohio Bureau of Workers' Compensation for a lumbar disk herniation between 2005 and 2012. The primary outcome was whether subjects return to work (RTW). To determine the impact time to surgery had on RTW status, the authors performed a multivariate logistic regression analysis. They compared other secondary outcomes using chi-square and t tests. The authors identified 1287 WC patients with single-level disk herniation and radiculopathy. Average time from injury to surgery was 364 days (range, 2-2710 days). The WC patients with shorter duration of radiculopathy before diskectomy had higher RTW rates; fewer physical therapy, chiropractic, and psychotherapy sessions; and fewer postoperative diagnoses of psychological illnesses (P<.05). A multivariate logistic regression model showed that time to surgery was an independent, negative predictor of RTW (odds ratio [OR], 0.97 per month; P<.01). Legal representation (OR, 0.56; P<.01), psychological comorbidity (OR, 0.32; P=.01), and mean household income (OR, 1.01 per $1000; P<.01) also significantly affected RTW status. These results confirm that the duration of radiculopathy due to single-level lumbar disk herniation has a predictive value for the WC population undergoing diskectomy. Within 12 weeks of injury, post-diskectomy patients do reasonably well, with 70.0% of subjects returning to work. [Orthopedics. 2021;44(1):e43-e49.].
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Ren BO, O'Donnell JA, Anderson JT, Haas AR, Percy R, Woods ST, Ahn UM, Ahn NU. The Impact of Smoking in Workers' Compensation Patients Receiving Spinal Cord Stimulation. J Surg Orthop Adv 2021; 30:185-189. [PMID: 34591011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The objective of this study was to determine the impact of smoking on clinical outcomes in workers' compensation (WC) patients receiving spinal cord stimulation (SCS). One hundred and ninety-six patients from the Ohio Bureau of Workers' Compensation were identified who received SCS with implantation occurring between 2007-2012. Patients were divided into smokers (n = 120) and nonsmokers (n = 76). Population characteristics before and after implantation were analyzed between the two groups. A multivariate logistic regression was run to determine predictors of return to work (RTW) status. Our regression determined smoking (p = 0.006; odds ratio [OR] = 0.260) and body mass index (p = 0.036; OR = 0.905) to be negative predictors of RTW status. After implantation, smokers were less likely to RTW after 6 months and had higher pain scores after 6 and 12 months. Both smokers and nonsmokers had significance reductions in opioid use after SCS implantation. (Journal of Surgical Orthopaedic Advances 30(3):185-189, 2021).
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Affiliation(s)
- Bryan O Ren
- University Hospitals Cleveland Medical Center Department of Orthopaedics Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jeffrey A O'Donnell
- Duke University School of Medicine Department of Orthopaedic Surgery, Durham, North Carolina
| | - Joshua T Anderson
- University of Utah School of Medicine Department of Orthopaedics, Salt Lake City, Utah
| | - Arnold R Haas
- Ohio Bureau of Workers' Compensation, Columbus, Ohio
| | - Rick Percy
- Ohio Bureau of Workers' Compensation, Columbus, Ohio
| | - Stephen T Woods
- Central Ohio Primary Care Sports, Spine & Joint, Westerville, Ohio; New Hampshire NeuroSpine Institute; Bedford, New Hampshire
| | | | - Nicholas U Ahn
- University Hospitals Cleveland Medical Center Department of Orthopaedics Case Western Reserve University School of Medicine, Cleveland, Ohio
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Ren BO, Rothfusz CA, Faour M, Anderson JT, O'Donnell JA, Haas AR, Percy R, Woods ST, Ahn UM, Ahn NU. Shorter Time to Surgery Is Associated With Better Outcomes for Spondylolisthesis in the Workers' Compensation Population. Orthopedics 2020; 43:154-160. [PMID: 32191949 DOI: 10.3928/01477447-20200314-04] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 12/23/2019] [Indexed: 02/03/2023]
Abstract
This study sought to determine the impact of time to surgery on clinical outcomes in patients with spondylolisthesis in the workers' compensation (WC) population. There is conflicting evidence regarding the effect of time to surgery on patients with spondylolisthesis. Patients receiving WC are known to have worse outcomes following spine surgery compared with the general population. A total of 791 patients from the Ohio Bureau of Workers' Compensation were identified who underwent lumbar fusion for spondylolisthesis between 1993 and 2013. The patients were divided into those who had surgery within 2 years of injury date and after 2 years. Confounding factors were corrected for in a multivariate logistic regression to determine predictors of return to work (RTW) status. Multivariate logistic regression determined that longer time to surgery (P=.003; odds ratio, 0.89 per year), age at index fusion (P=.003; odds ratio, 0.98 per year), and use of physical therapy before fusion (P=.008; odds ratio, 0.54) were negative predictors of RTW status. Patients who had surgery within 2 years were more likely to RTW and have fewer days absent from work, lower medical costs, and fewer sessions of psychotherapy, physical therapy, and chiropractor care. The authors demonstrated that for WC patients with spondylolisthesis, longer time to surgery was a negative predictor of RTW status. Patients who had surgery within 2 years of injury date were significantly more likely to RTW compared with after 2 years. [Orthopedics. 2020;43(3):154-160.].
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