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Albright P, Huyke-Hernández FA, Ormseth A, Doxey SA, Banks E, Only AJ, Horst PK, Cunningham BP. Preoperative Function Affects Ability to Achieve One-Year Minimum Clinically Important Difference for Patients Undergoing Total Knee Arthroplasty. Arthroplast Today 2024; 27:101377. [PMID: 38654887 PMCID: PMC11035092 DOI: 10.1016/j.artd.2024.101377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/20/2024] [Accepted: 03/12/2024] [Indexed: 04/26/2024] Open
Abstract
Background Minimum clinically important difference (MCID) values are commonly used to measure treatment success for total knee arthroplasty (TKA). MCID values vary according to calculation methodology, and prior studies have shown that patient factors are associated with failure to achieve MCID thresholds. The purpose of this study was to determine if anchor-based 1-year Knee Injury and Osteoarthritis Outcome Score Joint Replacement (KOOS-JR) MCID values varied among patients undergoing TKA based on patient-specific factors. Methods This was a retrospective review of patients undergoing TKA from 2017-2018. Patients without baseline or 1-year KOOS-JR or Patient-Reported Outcome Measurement Information System Global Health data or that underwent procedures other than primary TKA were excluded. MCIDs were calculated and compared between patient groups according to preoperative characteristics. Results Among the included 976 patients, 1-year KOOS-JR MCIDs were 26.6 for men, 28.2 for women, 30.7 for patients with a diagnosis of anxiety and/or depression, and 26.7 for patients without a diagnosis. One-year MCID values did not differ significantly according to gender (P = .379) or mental health diagnosis (P = .066), nor did they correlate with body mass index (β = -0.034, P = .822). Preoperative KOOS-JR decile demonstrated an inverse relationship with 1-year MCID values and attainment of MCID. Conclusions The proportion of patients attaining KOOS-JR MCID values demonstrated an inverse relationship with preoperative baseline function. Future investigation may identify patient factors that allow surgeons to better capture patient satisfaction with their procedure despite failure to attain a 1-year MCID.
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Affiliation(s)
- Patrick Albright
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Fernando A. Huyke-Hernández
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA
- Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington, MN, USA
| | - Andrew Ormseth
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Stephen A. Doxey
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA
- Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington, MN, USA
| | - Evan Banks
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Arthur J. Only
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Patrick K. Horst
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA
- Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington, MN, USA
| | - Brian P. Cunningham
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA
- Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington, MN, USA
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Doxey SA, Kleinsmith RM, Huyke-Hernández FA, Schweitzer A, Only AJ, Tompkins M, Kweon CY, Cunningham BP. Improved Patient-reported Outcomes in Patients Aged 16 and Younger at Two Years After Anterior Cruciate Ligament Reconstruction Despite Relatively High Rates of Reinjury and Repeat Surgery. J Pediatr Orthop 2024; 44:106-111. [PMID: 38031490 DOI: 10.1097/bpo.0000000000002567] [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: 12/01/2023]
Abstract
BACKGROUND Anterior cruciate ligament reconstruction (ACLR) in adolescent patients, particularly those aged 16 and under, are increasingly common procedure that lacks robust clinical and patient-reported outcome (PRO) data. The purpose of this study was to report 2-year PROs of patients receiving ACLR aged 16 or younger using the single assessment numerical evaluation (SANE) and knee injury and osteoarthritis outcome score (KOOS). Secondary aims included characterizing treatment characteristics, return to sport (RTS), and clinical outcomes. METHODS The institutional PRO database was queried for patients receiving ACLR from 2009 to 2020. Patients aged older than 16, revision procedures, concomitant ligament repairs/reconstructions, and patients without full outcome data at 2 years were excluded. Outcomes over 2 years after ACLR included SANE, KOOS, reinjuries, reoperations, and time to RTS. RESULTS A total of 98 patients were included with an average age of 15.0 years. Most patients were females (77.6%). Bone-tendon-bone autograft (69.4%) was the most used. Average RTS was 8.7 months (range: 4.8 to 24.0 mo), with 90% of patients eventually returning to sport. A total of 23 patients (23.5%) experienced a reinjury and 24.5% (n = 24) underwent reoperation. Timing to RTS was not associated with reinjury, but patients who returned between 9.5 and 13.7 months did not sustain reinjuries. Mean KOOS and SANE scores at 2 years were 87.1 and 89.1, respectively, with an average improvement of +18.4 and +22.9, respectively. Change in KOOS was negatively impacted by reinjury to the anterior cruciate ligament graft and reoperation (anterior cruciate ligament failure: +10.0 vs 19.3, P = 0.081, respectively; reoperation: +13.2 vs +20.1, P = 0.051, respectively), though these did not reach statistical significance. CONCLUSION Patients experienced improved SANE and KOOS scores after ACLR. Rates of reinjury and reoperation were relatively high and negatively impacted PRO scores but were not associated with the timing of RTS. Adolescent patients should be counseled regarding the risk of subsequent ipsilateral and contralateral knee injury after ACLR. LEVEL OF EVIDENCE Level IV-case series.
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Affiliation(s)
- Stephen A Doxey
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park
- Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington
| | - Rebekah M Kleinsmith
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park
- Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington
| | - Fernando A Huyke-Hernández
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park
- Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington
| | - Adam Schweitzer
- Department of Orthopaedic Surgery, Des Moines University College of Osteopathic Medicine, Des Moines, IA
| | - Arthur J Only
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
| | - Marc Tompkins
- Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington
| | | | - Brian P Cunningham
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park
- Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington
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Feroe AG, Only AJ, Murray JC, Malin LR, Mikhael N, Selley RS, Fader RR, Hassan MM. Use of Social Media in Orthopaedic Surgery Training and Practice: A Systematic Review. JB JS Open Access 2024; 9:e23.00098. [PMID: 38229872 PMCID: PMC10786589 DOI: 10.2106/jbjs.oa.23.00098] [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] [Indexed: 01/18/2024] Open
Abstract
Background Social media use has grown across healthcare delivery and practice, with dramatic changes occurring in response to the coronavirus (COVID-19) pandemic. The purpose of this study was to conduct a comprehensive systematic review to determine the current landscape of social media use by (1) orthopaedic surgery residencies/fellowship training programs and (2) individual orthopaedic surgeons and the change in use over time. Methods We searched 3 electronic databases (PubMed, MEDLINE, and Embase) from their inception to April 2022 for all studies that analyzed the use of social media in orthopaedic surgery. Two reviewers independently determined study eligibility, rated study quality, and extracted data. Methodology was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Twenty-eight studies were included, of which 11 analyzed social media use by orthopaedic surgery residency and fellowship training programs and 17 examined its use by individual orthopaedic surgeons. Among residency and fellowship programs, Instagram was identified as the most common platform used, with 42% to 88% of programs reporting program-specific Instagram accounts, followed by Twitter/X (20%-52%) and Facebook (10%-38%). Social media was most commonly used by programs for recruitment and information dissemination to prospective residency applicants (82% and 73% of included studies, respectively). After the start of the COVID-19 pandemic, there was a 620% and 177% increase in the number of training programs with Instagram and Twitter/X accounts, respectively. Individual use of social media ranged from 1.7% to 76% (Twitter/X), 10% to 73% (Facebook), 0% to 61% (Instagram), 22% to 61% (LinkedIn), and 6.5% to 56% (YouTube). Conclusions Instagram, Twitter/X, and Facebook are the premier platforms that patients, residency applicants, and institutions frequent. With the continued growth of social media use anticipated, it will be critical for institutions and individuals to create and abide by guidelines outlining respectful and professional integration of social media into practice. Level of Evidence Level IV.
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Affiliation(s)
- Aliya G. Feroe
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Arthur J. Only
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Jerome C. Murray
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Lynsey R. Malin
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Nizar Mikhael
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Ryan S. Selley
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital, Chicago, Illinois
| | | | - Mahad M. Hassan
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota
- TRIA Orthopaedic Center, Bloomington, Minnesota
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Huyke-Hernández FA, Doxey SA, Only AJ, Sibley A, Mikhael N, Kweon CY, Cunningham BP. Autograft patellar bone-tendon-bone use does not increase operative time in anterior cruciate ligament reconstruction. J Orthop 2023; 45:6-12. [PMID: 37809348 PMCID: PMC10551805 DOI: 10.1016/j.jor.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/20/2023] [Indexed: 10/10/2023] Open
Abstract
Background Anterior cruciate ligament reconstruction (ACLR) is a common procedure that has been shown to have relatively good outcomes amongst various graft types. Operative time in ACLR has been found to influence outcomes and cost. The purpose of this study was to evaluate the association of operative time in primary arthroscopically performed anterior cruciate ligament reconstruction (ACLR) and graft type while controlling for confounders that influence time. Methods All patients who received ACLR between 2018 and 2022 were included in this retrospective cohort study. Exclusion criteria consisted of age (≤16 years), revisions, concomitant ligament reconstruction or tendon repairs, or other simultaneously performed procedures that could potentially add substantial variation in operative time. The primary outcome was operative time. Graft types included allograft, bone-tendon-bone (BTB) autograft, hamstring tendon (HS) autograft and quadriceps tendon (QT) autograft. Results A total of 1813 primary ACLRs were included. The average operative time was 98.9 ± 33.0 min. Graft utilization varies considerably among surgeons. The most used graft type was BTB autograft (42.6%) followed by HS autograft (32.3%) and allograft (21.4%). Only 68 cases (3.8%) used a QT autograft. Seven of the 15 included surgeons primarily used BTB autograft. One surgeon predominately used QT autograft. No difference in operative time was observed among the autograft types (p = 0.342). Allograft ACLR was significantly faster by 27-33 min compared to using BTB autograft, HS autograft, or QT autograft (p < 0.001). Conclusion Operative time did not vary by type of autograft selected. Allograft ACLR was performed approximately 30 min faster than autograft ACLR. Further studies examining the effect on patient outcomes of reduced operative time and minimizing graft harvest morbidity in ACLR is important to more accurately determine the cost-effectiveness of allograft ACLR.
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Affiliation(s)
- Fernando A. Huyke-Hernández
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA
- Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington, MN, USA
| | - Stephen A. Doxey
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA
- Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington, MN, USA
| | - Arthur J. Only
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Andrew Sibley
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Nizar Mikhael
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | | | - Brian P. Cunningham
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA
- Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington, MN, USA
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Doxey S, Only AJ, Milshteyn M, Cunningham BP, Cannada LK. Are Canadian orthopaedic surgeons and American orthopaedic surgeons on par? A Canadian practice survey of orthopaedic traumatologists. OTA Int 2023; 6:e272. [PMID: 37020569 PMCID: PMC10069860 DOI: 10.1097/oi9.0000000000000272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 03/03/2023] [Indexed: 04/05/2023]
Abstract
Objectives: The purpose of this study was to obtain information on Canadian orthopaedic trauma surgeon practices and salary demographics. It was hypothesized that most of the practicing surgeons recognize specific practice aspects (compensation, call schedule, operating room availability, and provided support staff) as key factors in employment opportunity evaluation. Design: Cross-sectional survey study. Setting: Orthopaedic Trauma Association (OTA) practice surveys. Participants: All active Canadian members of the OTA were eligible to participate. Main Outcome Measurement: A 50-question survey was sent through email to OTA members assessing physician, practice, and compensation metrics of Canadian orthopaedic traumatologists. Results: Fifty-two of 113 Canadian OTA members participated giving a response rate of 46%. All surgeons worked in an academic practice, either for a university (83%) or community hospital (17%). Only 2% of surgeons have changed jobs in the last 5 years, and over 73% of surgeons maintain the same place of employment during their careers. Most had an available dedicated orthopaedic trauma operating room (73%). The majority indicated having residents (71%) and fellows (63%) as support staff. Many reported completing 300–500 cases per year (42%), which decreased during COVID-19 for 50% of surgeons. The most common reported compensation was between $400,000 and $600,000 US dollars (25%) with many working 4–6 call shifts a month (48%) and 51–70 hours a week (48%). Conclusion: This study demonstrated the varying practice and physician economic variables currently in Canada. The identification and continued surveillance of these employment variables will allow for transparency in job market evaluation by applicants. Level of Evidence: Level V.
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Affiliation(s)
- Stephen Doxey
- Department of Orthopaedic Surgery, TRIA Orthopaedic Center, Bloomington, MN
| | - Arthur J. Only
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
| | - Michael Milshteyn
- Department of Orthopaedic Surgery, McLaren Macomb Orthopedics and Trauma, Mount Clemens, MI; and
| | | | - Lisa K. Cannada
- Department of Orthopaedic Surgery, Novant Health Orthopaedic Fracture Clinic, Charlotte, NC
- Corresponding author. Address: Orthopaedic Trauma Surgeon, Novant Health Orthopaedic Fracture Clinic, 449 N Wendover Rd # A, Charlotte, NC 28211. E-mail address: (Lisa K. Cannada)
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Huyke-Hernández FA, Only AJ, Leslie EK, Schroder LK, Switzer JA. Creative bracing: A descriptive overview of an alternative technique for non-operative fracture management of frail older adults. Int J Orthop Trauma Nurs 2022; 47:100982. [PMID: 36459710 DOI: 10.1016/j.ijotn.2022.100982] [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: 06/15/2022] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
As the world population ages, a higher proportion of older and frailer patients will sustain fragility fractures. Considering their depleted physiologic reserve and potentially different goals of care at their stage in life, these patients; especially those enrolled in hospice care, with profound dementia, or at end-of-life care; may not benefit from traditional surgical methods of fracture care. Non-operative treatment using standard immobilization or casting techniques in older and frailer patients can still render them susceptible to complications and adverse events. Here we describe our alternative non-operative treatment method of creative bracing to address the needs of this specific population. Creative bracing can be done with simple supplies available in almost all healthcare settings. Through patient-specific pre-treatment assessment, a creative brace tailored to the patient's risk factors and goals of care can be designed to provide sufficient fracture immobilization and comfort. Creative bracing is a low-cost, low-technical demand modality for non-operative treatment of some fragility fractures. Its benefit can be appreciated to greatest effect in the frailest patients for whom standard, surgical treatment does not represent best care.
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Affiliation(s)
- Fernando A Huyke-Hernández
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA; Department of Orthopaedic Surgery, TRIA Orthopaedic Center, Bloomington, MN, USA
| | - Arthur J Only
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA; Department of Orthopaedic Surgery, TRIA Orthopaedic Center, Bloomington, MN, USA
| | - Erin K Leslie
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN, USA
| | | | - Julie A Switzer
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA; Department of Orthopaedic Surgery, TRIA Orthopaedic Center, Bloomington, MN, USA; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.
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Huyke-Hernández FA, Only AJ, Sorich M, Onizuka N, Switzer JA, Cunningham BP. Outcomes After Revision Fixation With Cement Augmentation for Failed Intertrochanteric Fracture Fixation in Older Adult Patients. Geriatr Orthop Surg Rehabil 2022; 13:21514593221135480. [PMID: 36310893 PMCID: PMC9608033 DOI: 10.1177/21514593221135480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 09/17/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Intertrochanteric (IT) fractures that fail fixation are traditionally treated with arthroplasty, introducing significant risk of morbidity and mortality in frail older adult patients. Revision fixation with cement augmentation is a relatively novel technique that has been reported in several small scale international studies. Here we report a clinical series of 22 patients that underwent revision fixation with cement augmentation for IT fracture fixation failure. Methods This retrospective case series identified all patients that underwent revision intramedullary nailing from 2018 to 2021 at two institutions within a large metropolitan healthcare system. Demographics, injury characteristics, Charlson Comorbidity Index score, and surgical characteristics were extracted from the electronic medical record. Outcomes were extracted from the electronic medical record and included radiographic findings, pain, functional outcomes, complications, and mortality. Results Average follow-up after revision surgery was 15.2 ± 10.6 months. Twenty patients (90.9%) reported improved pain and achieved union or progressive healing after surgery. Most of these patients regained some degree of independent ambulation (19 patients, 86.4%), with only 5 patients (22.7%) requiring increased assistance for their activities of daily living (ADLs). One-year mortality was 13.6% (3 patients). Of the 5 patients (22.7%) that experienced complications, 2 patients (9.1%) required revision hemiarthroplasty for subsequent fixation failure. The other 3 patients did well when complications resolved. Conclusions Revision fixation with cement augmentation can be an effective, safe, cost-effective alternative to arthroplasty for the management of cases involving non-infected failed IT fracture fixation with implant cut-out or cut-through limited to the femoral head in older adult patients that have appropriate acetabular bone stock.
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Affiliation(s)
- Fernando A. Huyke-Hernández
- Department of Orthopaedic Surgery, TRIA Orthopaedic Center, Bloomington, MN, USA,Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA
| | - Arthur J. Only
- Department of Orthopaedic Surgery, TRIA Orthopaedic Center, Bloomington, MN, USA,Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA
| | - Megan Sorich
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Naoko Onizuka
- Department of Orthopaedic Surgery, TRIA Orthopaedic Center, Bloomington, MN, USA,Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA,Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Julie A. Switzer
- Department of Orthopaedic Surgery, TRIA Orthopaedic Center, Bloomington, MN, USA,Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA,Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Brian P. Cunningham
- Department of Orthopaedic Surgery, TRIA Orthopaedic Center, Bloomington, MN, USA,Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA,Brian P. Cunningham MD, Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, 6500 Excelsior Boulevard, St Louis Park, MN 55426, USA.
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Huyke-Hernández FA, Only AJ, Nguyen AS, Onizuka N, Switzer JA. Low-energy suspiciously open proximal humerus fracture management in older adult patient: A case report. Trauma Case Rep 2022; 41:100686. [PMID: 35942321 PMCID: PMC9356296 DOI: 10.1016/j.tcr.2022.100686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Fernando A. Huyke-Hernández
- Department of Orthopaedic Surgery, Methodist Hospital, St. Louis Park, MN, USA
- Department of Orthopaedic Surgery, TRIA Institute, Bloomington, MN, USA
| | - Arthur J. Only
- Department of Orthopaedic Surgery, Methodist Hospital, St. Louis Park, MN, USA
- Department of Orthopaedic Surgery, TRIA Institute, Bloomington, MN, USA
| | - Arthur S. Nguyen
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Naoko Onizuka
- Department of Orthopaedic Surgery, Methodist Hospital, St. Louis Park, MN, USA
- Department of Orthopaedic Surgery, TRIA Institute, Bloomington, MN, USA
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Julie A. Switzer
- Department of Orthopaedic Surgery, Methodist Hospital, St. Louis Park, MN, USA
- Department of Orthopaedic Surgery, TRIA Institute, Bloomington, MN, USA
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
- Corresponding author at: 6500 Excelsior Blvd., St. Louis Park, MN 55426, USA.
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Okelana B, McMillan L, Huyke-Hernandez FA, Only AJ, Parikh HR, Cunningham BP. Cost Variation in Temporizing External Fixation of Tibial Plateau and Pilon Fractures: Is There Room to Improve? Injury 2022; 53:2872-2879. [PMID: 35760640 DOI: 10.1016/j.injury.2022.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/11/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION External fixator costs have been shown to be highly variable. Current information on external fixator costs and cost drivers is limited. The aim of this study was to examine the cost variation as well as the patient-, injury-, and surgeon-related cost drivers associated with temporizing external fixation constructs in tibial plateau and pilon fracture management. MATERIALS AND METHODS A retrospective review was conducted to identify isolated tibial plateau and pilon fractures treated with temporizing external fixation from 2006-2018 at a level 1 trauma center. Inclusion criteria were based on fractures managed with primary external fixation, skeletal maturity, and isolated ipsilateral fracture fixation. Fracture patterns were identified radiographically using Schatzker, Weber, and OTA classification systems. Implant costs were determined using direct purchase price from the institution. The primary outcome was the external fixator total construct cost. Clinical covariates and secondary outcomes, namely unplanned reoperations, were extracted. Factors associated with cost (i.e. cost drivers) were identified via multivariable regression analysis. RESULTS A total of 319 patients were included in this study (121 tibial plateau and 198 pilon fractures). Mean plateau construct cost was $5,372.12 and mean pilon construct cost was $3,938.97. Implant cost correlated poorly with demographic (r2=0.01 & r2=0.01), injury-independent (r2<0.01 & r2=0.03), and fracture pattern classifications (r2=0.03 & r2=0.02). Traumatologists produced significantly cheaper implants for pilon fractures (p=0.05) but not for plateau fractures (p=0.85). There was no difference in construct cost or components between patients that underwent unplanned reoperation and those that did not for both tibial plateau (p>0.19) and pilon (p>0.06). Clamps contributed to 69.9% and 77.3% of construct costs for tibial plateau and pilon, respectively. The most cost-efficient fixation constructs for tibial plateau and pilon fractures were the following respectively: of 5 clamps, 2 bars, and 4 pins; and of 4 clamps, 2 bars, and 3 pins. CONCLUSIONS There is large cost variation in temporizing external fixation management. Cost drivers included surgeon bias and implant preference as well as use of external fixator clamps. Introducing construct standardization will contain healthcare spending without sacrificing patient outcomes. LEVEL OF EVIDENCE Level III. Retrospective Cohort.
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Affiliation(s)
- Bandele Okelana
- Department of Orthopaedic Surgery, The University of Texas at Austin, Austin, TX, USA
| | - Logan McMillan
- Department of Orthopaedic Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Fernando A Huyke-Hernandez
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA; Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington, MN, USA
| | - Arthur J Only
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA; Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington, MN, USA
| | - Harsh R Parikh
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA
| | - Brian P Cunningham
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA; Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington, MN, USA.
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Jabara JT, Only AJ, Paull TZ, Wise KL, Swiontkowski MF, Nguyen MP. Arthroscopically Assisted Percutaneous Screw Fixation of Tibial Plateau Fractures. JBJS Essent Surg Tech 2022; 12:ST-D-21-00026. [PMID: 36741037 PMCID: PMC9889297 DOI: 10.2106/jbjs.st.21.00026] [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] [Indexed: 02/07/2023] Open
Abstract
Tibial plateau fractures account for approximately 1% to 2% of fractures in adults1. These fractures exhibit a bimodal distribution as high-energy fractures in young patients and low-energy fragility fractures in elderly patients. The goal of operative treatment is restoration of joint stability, limb alignment, and articular surface congruity while minimizing complications such as stiffness, infection, and posttraumatic osteoarthritis. Open reduction and internal fixation with direct visualization of the articular reduction or indirect evaluation with fluoroscopy has traditionally been the standard treatment for displaced tibial plateau fractures. However, there has been concern regarding inadequate visualization of the articular surface with open tibial plateau fracture fixation, contributing to a fivefold increase in conversion to total knee arthroplasty2. In addition, the risk of wound complications and infection has been reported to be as high as 12%3,4. Knee arthroscopy with percutaneous, cannulated screw fixation provides a less invasive procedure with excellent visualization of the articular surface and allows for accurate reduction and fracture fixation compared with traditional open reduction and internal fixation techniques1. Recent studies of arthroscopically assisted percutaneous screw fixation of tibial plateau fractures have reported excellent early clinical and radiographic outcomes and low complication rates3,5,6. Description This technique involves the use of both arthroscopy and fluoroscopy to facilitate reduction and fixation of the tibial plateau fracture. Through a minimally invasive technique, the depressed articular joint surface is targeted with use of preoperative computed tomography (CT) scans and intraoperative biplanar fluoroscopy. Reduction is then directly visualized with arthroscopy and fixation is performed with use of fluoroscopy. Lastly, restoration of the articular surface is confirmed with use of arthroscopy after definitive fixation. Modifications can be made as needed. Alternatives The traditional method for fixation of displaced tibial plateau fractures is open reduction and internal fixation. Articular reduction can be visualized directly with an open submeniscal arthrotomy and an ipsilateral femoral distractor or indirectly with fluoroscopy. Rationale Visualization of the articular surface is essential to achieve anatomic reduction of the joint line. Inspection of the posterior plateau is difficult with an open surgical approach. Arthroscopically assisted percutaneous screw fixation of a tibial plateau fracture may allow for improved restoration of articular surfaces through enhanced visualization. Less soft-tissue dissection is associated with lower morbidity and may result in less damage to the blood supply, lower rates of infection and wound complications, faster healing, and better mobility for patients. In our experience, this technique has been successful in patients with severe osteoporosis and comminution of depressed fragments. If total knee arthroplasty is required, we have also observed less damage to the blood supply and fewer surgical scars with use of this surgical technique. Expected Outcomes Arthroscopically assisted percutaneous screw fixation of a tibial plateau fracture facilitates anatomical reduction through a less invasive approach. Patients undergoing this method of tibial plateau fracture fixation are able to engage earlier in rehabilitation2. Studies have shown early postoperative range of motion, excellent patient-reported outcomes, and minimal complications7,8. Important Tips Arthroscopically assisted fixation can be applied to a variety of tibial plateau fractures; however, the minimally invasive approach is best suited for patients with isolated lateral tibial plateau fractures (Schatzker I to III) and a cortical envelope that can be easily restored. The cortical envelope refers to the outer rim of the tibial plateau. Fracture pattern and ligamentotaxis determine the cortical envelope, which can be evaluated on preoperative CT scans. In our experience, even depressed segments with a high degree of comminution may be treated with use of this technique with satisfactory results.Articular depression should be targeted with use of a preoperative CT scan and intraoperative fluoroscopy and arthroscopy.The surgeon should be careful not to "push up" in 1 small area; rather, a "joker" elevator or bone tamp should be utilized, moving anterior to posterior, which can be frequently assessed with arthroscopy.The intra-articular pressure of the arthroscopy irrigation fluid should be low (≤45 mm Hg or gravity flow), and the operative extremity should be monitored for compartment syndrome throughout the procedure. Acronyms and Abbreviations ACL = anterior cruciate ligamentK-wires = Kirschner wiresORIF = open reduction and internal fixationAP = anteroposteriorCR = computed radiography.
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Affiliation(s)
- Justin T. Jabara
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota,Email for corresponding author:
| | - Arthur J. Only
- Department of Orthopaedic Surgery, TRIA Orthopedic Center, Bloomington, Minnesota
| | - T. Zach Paull
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota
| | - Kelsey L. Wise
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Marc F. Swiontkowski
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota,Department of Orthopaedic Surgery, TRIA Orthopedic Center, Bloomington, Minnesota
| | - Mai P. Nguyen
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota,Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota
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Nguyen AS, Only AJ, Onizuka N, Switzer JA. Medial femoral circumflex artery pseudoaneurysm following intramedullary nailing for intertrochanteric fracture. Trauma Case Rep 2022; 37:100577. [PMID: 35005160 PMCID: PMC8715203 DOI: 10.1016/j.tcr.2021.100577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2021] [Indexed: 11/01/2022] Open
Abstract
Case We present the case of a 92-year-old woman who developed a medial femoral circumflex artery (MFCA) pseudoaneurysm intraoperatively while obtaining reduction during intramedullary nailing (IMN) for intertrochanteric fracture. Conclusions Pseudoaneurysms are rare vascular complications in hip fracture surgery. Early recognition of signs and symptoms of this phenomenon are essential for diagnosis and treatment. Close post-operative monitoring and serial hemoglobin should be considered for unexplained intra-operative bleeding. A low threshold for angiography should be entertained if active bleeding and clinical decompensation occur during instrumented percutaneous pertrochanteric fracture reduction. This patient underwent conventional angiography with successful coil embolization and exclusion of the MFCA pseudoaneurysm.
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Affiliation(s)
- Arthur S Nguyen
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Arthur J Only
- Department of Orthopaedic Surgery, Methodist Hospital, Saint Louis Park, MN, USA
| | - Naoko Onizuka
- Department of Orthopaedic Surgery, Methodist Hospital, Saint Louis Park, MN, USA.,Department of Orthopaedic Surgery, University of Minnesota, MN, USA
| | - Julie A Switzer
- Department of Orthopaedic Surgery, Methodist Hospital, Saint Louis Park, MN, USA.,Department of Orthopaedic Surgery, University of Minnesota, MN, USA
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Flagstad IR, Tatman LM, Albersheim M, Heare A, Parikh HR, Vang S, Westberg JR, de Chaffin DR, Schmidt T, Breslin M, Simske N, Siy AB, Lufrano RC, Rodriguez-Buitrago AF, Labrum JT, Shaw N, Only AJ, Nadeau J, Davis P, Steverson B, Lund EA, Connelly D, Atchison J, Mauffrey C, Hak DJ, Titter J, Feinstein S, Hahn J, Sagi C, Whiting PS, Mir HR, Schmidt AH, Wagstrom E, Obremskey WT, O'Toole RV, Vallier HA, Cunningham B. Factors influencing management of bilateral femur fractures: A multicenter retrospective cohort of early versus delayed definitive Fixation. Injury 2021; 52:2395-2402. [PMID: 33712297 DOI: 10.1016/j.injury.2021.02.091] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/16/2021] [Accepted: 02/28/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The purpose of our study was to evaluate the factors that influence the timing of definitive fixation in the management of bilateral femoral shaft fractures and the outcomes for patients with these injuries. METHODS Patients with bilateral femur fractures treated between 1998 to 2019 at ten level-1 trauma centers were retrospectively reviewed. Patients were grouped into early or delayed fixation, which was defined as definitive fixation of both femurs within or greater than 24 hours from injury, respectively. Statistical analysis included reversed logistic odds regression to predict which variable(s) was most likely to determine timing to definitive fixation. The outcomes included age, sex, high-volume institution, ISS, GCS, admission lactate, and admission base deficit. RESULTS Three hundred twenty-eight patients were included; 164 patients were included in the early fixation group and 164 patients in the delayed fixation group. Patients managed with delayed fixation had a higher Injury Severity Score (26.8 vs 22.4; p<0.01), higher admission lactate (4.4 and 3.0; p<0.01), and a lower Glasgow Coma Scale (10.7 vs 13; p<0.01). High-volume institution was the most reliable influencer for time to definitive fixation, successfully determining 78.6% of patients, followed by admission lactate, 64.4%. When all variables were evaluated in conjunction, high-volume institution remained the strongest contributor (X2 statistic: institution: 45.6, ISS: 8.83, lactate: 6.77, GCS: 0.94). CONCLUSION In this study, high-volume institution was the strongest predictor of timing to definitive fixation in patients with bilateral femur fractures. This study demonstrates an opportunity to create a standardized care pathway for patients with these injuries. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Ilexa R Flagstad
- Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street R200, Minneapolis, MN 55455, USA
| | - Lauren M Tatman
- Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street R200, Minneapolis, MN 55455, USA
| | - Melissa Albersheim
- Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street R200, Minneapolis, MN 55455, USA
| | - Austin Heare
- Department of Orthopaedic Surgery, University of Miami Hospital Ortho Clinic, 1400 N.W. 12th Avenue, Suite 2, Miami, FL 33136, USA
| | - Harsh R Parikh
- Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street R200, Minneapolis, MN 55455, USA
| | - Sandy Vang
- Department of Orthopaedic Surgery, Regions Hospital, 640 Jackson Street, Saint Paul, MN 55101, USA
| | - Jerald R Westberg
- Department of Orthopaedic Surgery, Hennepin Healthcare, 730 South 8th Street, Minneapolis, MN 55415, USA
| | - Danielle Ries de Chaffin
- Department of Orthopaedic Surgery, Hennepin Healthcare, 730 South 8th Street, Minneapolis, MN 55415, USA
| | - Tegan Schmidt
- Department of Orthopaedic Surgery, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Mary Breslin
- Department of Orthopaedic Surgery, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
| | - Natasha Simske
- Department of Orthopaedic Surgery, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
| | - Alexander B Siy
- Department of Orthopaedic Surgery, University of Wisconsin Hospital and Clinic, 1685 Highland Ave, Madison, WI 53705, USA
| | - Reuben C Lufrano
- Department of Orthopaedic Surgery, University of Wisconsin Hospital and Clinic, 1685 Highland Ave, Madison, WI 53705, USA
| | - Andres F Rodriguez-Buitrago
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South MCE South Tower, Suite 4200, Nashville, TN 37232, USA
| | - Joseph T Labrum
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South MCE South Tower, Suite 4200, Nashville, TN 37232, USA
| | - Nichole Shaw
- Department of Orthopaedic Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Arthur J Only
- Department of Orthopaedic Surgery, Methodist Hospital, 6500 Excelsior Boulevard, St. Louis Park, MN 55426, USA
| | - Jason Nadeau
- Department of Orthopaedic Surgery, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204, USA
| | - Patrick Davis
- Department of Orthopaedic Surgery, Florida Orthopaedic Institute, 909 North Dale Mabry Highway, Tampa, FL 33609, USA
| | - Barbara Steverson
- Department of Orthopaedic Surgery, Florida Orthopaedic Institute, 909 North Dale Mabry Highway, Tampa, FL 33609, USA
| | - Erik A Lund
- Department of Orthopaedic Surgery, Florida Orthopaedic Institute, 909 North Dale Mabry Highway, Tampa, FL 33609, USA
| | - Daniel Connelly
- Department of Orthopaedic Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Jared Atchison
- Department of Orthopaedic Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Cyril Mauffrey
- Department of Orthopaedic Surgery, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204, USA
| | - David J Hak
- Department of Orthopaedic Surgery, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204, USA
| | - Julie Titter
- Department of Orthopaedic Surgery, University of North Carolina, 130 Mason Farm Road CB# 7055 UNC School of Medicine, Chapel Hill, NC 27599, USA
| | - Shawn Feinstein
- Department of Orthopaedic Surgery, University of North Carolina, 130 Mason Farm Road CB# 7055 UNC School of Medicine, Chapel Hill, NC 27599, USA
| | - Jesse Hahn
- Department of Orthopaedic Surgery, University of North Carolina, 130 Mason Farm Road CB# 7055 UNC School of Medicine, Chapel Hill, NC 27599, USA
| | - Claude Sagi
- Department of Orthopaedic Surgery, University of Cincinnati, Medical Sciences Building Room 3109 231 Albert Sabin Way, PO Box 670531, Cincinnati, OH 45267, USA
| | - Paul S Whiting
- Department of Orthopaedic Surgery, University of Wisconsin Hospital and Clinic, 1685 Highland Ave, Madison, WI 53705, USA
| | - Hassan R Mir
- Department of Orthopaedic Surgery, Florida Orthopaedic Institute, 909 North Dale Mabry Highway, Tampa, FL 33609, USA
| | - Andrew H Schmidt
- Department of Orthopaedic Surgery, Hennepin Healthcare, 730 South 8th Street, Minneapolis, MN 55415, USA
| | - Emily Wagstrom
- Department of Orthopaedic Surgery, Hennepin Healthcare, 730 South 8th Street, Minneapolis, MN 55415, USA
| | - William T Obremskey
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South MCE South Tower, Suite 4200, Nashville, TN 37232, USA
| | - Robert V O'Toole
- Department of Orthopaedic Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Heather A Vallier
- Department of Orthopaedic Surgery, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
| | - Brian Cunningham
- Department of Orthopaedic Surgery, Methodist Hospital, 6500 Excelsior Boulevard, St. Louis Park, MN 55426, USA.
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Lindell JS, Blaschke BL, Only AJ, Parikh HR, Gorman TL, Vang SX, Mahajan AY, Cunningham BP. The Cost of Care Associated with Microvascular Free Tissue Transfer by Anatomical Region: A Time-Driven Activity-Based Model. Journal of Reconstructive Microsurgery Open 2021. [DOI: 10.1055/s-0041-1729639] [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] [Indexed: 10/21/2022] Open
Abstract
Abstract
Background Microvascular free tissue transfer (FTT) is a reliable method for reconstruction of complex soft tissue defects. The goal of this study was to utilize time-driven activity-based cost (TDABC) accounting to measure the total cost of care of FTT and identify modifiable cost drivers.
Methods A retrospective review was performed on patients requiring FTT at a single, level-I academic trauma center from 2013 to 2019. Patient and surgical characteristics were collected, and six prospective FTT cases were observed via TDABC to collect direct and indirect costs of care.
Results When stratified by postoperative stay at intensive care units (ICUs), the average cost of care was $21,840.22, while cases without ICU stay averaged $6,646.61. The most costly category was ICU stay, averaging $8,310.99 (40.9% of nonstratified overall cost). Indirect costs were the second most costly category, averaging $4,388.07 (21.6% of nonstratified overall cost). Overall, 13 of 100 reviewed cases required some form of revision free-flap, increasing cumulative costs to $7,961.34 for cases with non-ICU stay and $22,233.85 for cases with ICU stay, averaging up to $44,074.07 for patients who stayed in the ICU for both procedures. An increase in cumulative cost was also observed within the timeframe of the investigation, with average costs of $8,484.00 in 2013 compared to $45,128 for 2019.
Conclusion Primary drivers for cost in this study were ICU stay and revision/reoperation. Better understanding the cost of FTT allows for cost reduction through the development of new protocols that drive intraoperative efficiency, reduce ICU stays, and optimize outcomes.
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Affiliation(s)
- Jackson S. Lindell
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota
| | - Breanna L. Blaschke
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota
- Department of Orthopaedic Surgery, TRIA Orthopaedic Center, Bloomington, Minnesota
| | - Arthur J. Only
- Department of Orthopaedic Surgery, Methodist Hospital, St. Louis Park, Minnesota
| | - Harsh R. Parikh
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Tiffany L. Gorman
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Sandy X. Vang
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Ashish Y. Mahajan
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota
| | - Brian P. Cunningham
- Department of Orthopaedic Surgery, Methodist Hospital, St. Louis Park, Minnesota
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Sperring TR, Only AJ, Wintermeyer E, DeRogatis MJ, Issack PS. Acetabular Fracture Resulting from a Basketball Cutting Movement in a Young Adult Male: A Case Report. JBJS Case Connect 2019; 9:e0398. [PMID: 31634151 DOI: 10.2106/jbjs.cc.18.00398] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CASE We present the case of a 26-year-old man who sustained a right transverse-posterior wall acetabular fracture while performing a cutting movement playing basketball. CONCLUSIONS Acetabular fracture after a relatively low-energy injury in a healthy young adult male is an extremely unusual event. The cutting movement to the right likely forcefully placed the right hip in flexion, adduction, and internal rotation directing the femoral head into the posterior wall. The patient had excellent clinical and radiographic results after acetabular open reduction and internal fixation.
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Affiliation(s)
- Thomas R Sperring
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital, New York, New York
| | - Arthur J Only
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital, New York, New York
| | - Elke Wintermeyer
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital, New York, New York
- Department of Trauma and Reconstructive Surgery, BG Trauma Center, Tuebingen, Germany
| | - Michael J DeRogatis
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital, New York, New York
| | - Paul S Issack
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital, New York, New York
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Only AJ, DeChristopher PJ, Iqal O, Fareed J. Restoration of Normal Prothrombin Time/International Normalized Ratio With Fresh Frozen Plasma in Hypocoagulable Patients. Clin Appl Thromb Hemost 2014; 22:85-91. [PMID: 25294634 DOI: 10.1177/1076029614550819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Fresh frozen plasma (FFP) is an effective reversal agent for hypocoagulable patients. Its proven efficacy continues to prompt its usage as both a prophylactic and a therapeutic therapy. Although published guidelines encouraging the appropriate administration of FFP exist, overutilization continues. The purpose of these ex vivo studies was to determine the effects of succeeding volumes of FFP supplementation on hypocoagulable plasma prothrombin time/international normalized ratio (PT/INR). By analyzing the decline in PT/INR with varying volumes of FFP, a minimal required volume of FFP could be identified representing the optimal volume to administer while still providing therapeutic effect. A total of 497 plasma samples were screened for elevated PT/INR values and 50 samples were selected for inclusion in this experiment. The initial PTs/INRs ranged from 12.5 to 43.4 seconds/1.42 to 4.91. Subsequent declines in PT/INR values were analyzed following addition of 50, 100, and 150 µL of FFP to a fixed volume of 250 µL of plasma (26.4 ± 5.318 seconds/2.99 ± 0.603, 13.3 ± 1.077 seconds/1.51 ± 0.122, 11.2 ± 0.712 seconds/1.27 ± 0.081, and 10.3 ± 0.533 seconds/1.16 ± 0.06, respectively). A nonlinear relationship between decline in INR values and percentage of FFP supplementation was demonstrated. The greatest effect on INR was obtained after supplementation with 50 µL (49%). Doubling and tripling the volume of FFP lead to significantly lower declines in INR (16% and 8%, respectively). Analysis of variance indicated a statistical significance with subsequent volume supplementation of FFP, but marginal clinical benefits exist between the PTs/INRs obtainable with increased FFP volume administration.
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Affiliation(s)
- Arthur J Only
- Department of Pathology, Loyola University Chicago, Maywood, IL, USA
| | | | - Omer Iqal
- Department of Pathology, Loyola University Chicago, Maywood, IL, USA
| | - Jawed Fareed
- Department of Pathology, Loyola University Chicago, Maywood, IL, USA
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