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Shahait A, Pearl A, Saleh KJ. Outcomes of Colectomy in United States Veterans With Cirrhosis: Predicting Outcomes Using Nomogram. J Surg Res 2024; 293:570-577. [PMID: 37832308 DOI: 10.1016/j.jss.2023.09.055] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION With growing incidence of liver cirrhosis worldwide, there is more need for a risk assessment tool to aid in perioperative management of cirrhotic patients undergoing colorectal procedures. We aim to assess the association of open (OC) versus laparoscopic (LC) approach with colorectal procedures' outcomes and develop an easy-to-use nomogram to predict outcomes. METHODS We analyzed the Veterans Affairs Surgical Quality Improvement Program to identify all patients with cirrhosis and ascites who underwent colorectal procedures from 2008 to 2015. Model for End-stage Liver Disease score was calculated as well as five-items modified frailty index. The chi-square test was utilized to analyze categorical variables. Two-sided unpaired Student's t-test or Mann-Whitney U-test were used for numerical variables as appropriate. Multivariate logistic regression adjusting for demographics, comorbidities, and other preoperative factors was used to analyze postoperative outcomes. A predictive nomogram was constructed and internally validated. RESULTS A total of 731 patients were identified. Overall, complications occurred in 48.2% of patients, and 30-d mortality was 24.8%, with 57.5% were performed emergently. Malignant neoplasm was the most common indication (25.4%). LC was performed in 22.4%, with shorter operative time, less blood transfusions, shorter length of stay, and lower morbidity compared to OC. Overall, Model for End-stage Liver Disease score was an independent factor of mortality, while laparoscopic approach had a protective effect on morbidity. An easy-to-use nomogram was generated for morbidity and 30-d mortality with calculated area under cure of 74.5% and 77.9%, respectively, indicating reliability. CONCLUSIONS Although colectomy is a high-risk operation in cirrhotic veterans, LC may have favorable outcomes than OC in selected patients. An easy-to-use nomogram to predict morbidity and mortality for cirrhotic patients undergoing colectomy is proposed.
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Affiliation(s)
- Awni Shahait
- Departement of Surgery, Southern Illinois University School of Medicine, Carbondale, Illinois; Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, Michigan.
| | - Adam Pearl
- Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, Michigan
| | - Khaled J Saleh
- Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, Michigan
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2
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Hasan A, Pearl A, Daher M, Saleh KJ. Patient genetic heterogeneities acting as indicators of post-operative pain and opioid requirement in orthopedic surgery: A systematic review. J Opioid Manag 2024; 20:77-85. [PMID: 38533718 DOI: 10.5055/jom.0809] [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: 03/28/2024]
Abstract
INTRODUCTION Orthopedic surgical procedures are expected to increase annually, making it imperative to understand the correlations between patient genetic makeup and post-operative pain levels. METHODS We performed a systematic literature review using PubMed and Cochrane databases in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 299 articles were initially selected, 20 articles remained after title and abstract review, and nine articles were selected for inclusion upon full text review. RESULTS Genetic risk factors identified included the A allele of the 5HT2A gene single nucleotide polymorphism, the AA genotype of the ADRB2 gene, the CG genotype of the IL6 gene, the genotypes CT and TT of the NTRK1 gene, genotypes AA and GA of the OPRM gene, and the AA and GA genotypes of the COMT gene. Additional studies in the review discuss statistical significance of other variants of the COMT gene. CONCLUSION There have been genetic association studies performed on the patient heterogeneity and its relationship on patient pain levels, but more data need to be collected to understand the clinical utility of stratifying patients based on genomic sequence.
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Affiliation(s)
- Ahmad Hasan
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit; Department of Research, Fajr Scientific, Ann Arbor, Michigan
| | - Adam Pearl
- Department of Emergency Medicine, HCA Aventura Hospital, Aventura, Florida
| | - Mohammad Daher
- Orthopedics Department, Brown University, Providence, Rhode Island. ORCID: https://orcid.org/0000-0002-9256-9952
| | - Khaled J Saleh
- Department of Research, Fajr Scientific, Ann Arbor; Department of Research, John D Dingell VAMC, Detroit, Michigan
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Daher M, Pearl A, Zalaquett Z, Elhassan BT, Abboud JA, Fares MY, Saleh KJ. InSpace Balloon for the Management of Massive Irreparable Rotator Cuff Tears: A Systematic Review and Meta-Analysis. Clin Orthop Surg 2023; 15:834-842. [PMID: 37811509 PMCID: PMC10551680 DOI: 10.4055/cios23032] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/20/2023] [Accepted: 04/17/2023] [Indexed: 10/10/2023] Open
Abstract
Background The best course of action for massive irreparable rotator cuff tears (MIRCTs) is not universally agreed upon. Numerous surgical techniques have been discussed. The implantation of a biodegradable spacer into the subacromial area has been documented since 2012 by several authors. The implantation method is touted as being simpler, repeatable, and less invasive than other solutions that are now available. The purpose of this systematic review and meta-analysis, being the first of its kind, was to evaluate the literature to see the efficacy of InSpace balloon (ISB) implantation in the management of MIRCTs. Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, and with 2 researchers assessing and analyzing each study separately, an extensive electronic search of the literature was conducted in the PubMed database from 1961 until July 27, 2022. Results Fourteen studies were included in this systematic review and three in the meta-analysis. Eleven out of fourteen studies favored ISB use for MIRCTs, while only three were against its use. All spacers were arthroscopically implanted in the subacromial space. Three studies were included in the meta-analysis. The differences in the compared outcomes were statistically insignificant. Conclusions A controversy about the use of ISB remains in patients with MIRCTs. Both good and bad outcomes were reported. However, the majority of patients had good clinical outcomes across several grading scales, radiographic evidence of improved impingement, and self-report that they would redo the procedure in hindsight. To draw more solid conclusions and have statistically significant results in the meta-analysis, more randomized controlled trials and comparative studies comparing this device to other treatments are needed.
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Affiliation(s)
- Mohammad Daher
- Department of Orthopedics, Hotel Dieu de France, Saint Joseph University, Beirut, Lebanon
| | - Adam Pearl
- Department of Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ziad Zalaquett
- Department of Orthopedic Surgery, Hotel Dieu de France, Saint Joseph University, Beirut, Lebanon
| | - Bassem T Elhassan
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph A Abboud
- Department of Orthopedics, Hotel Dieu de France, Saint Joseph University, Beirut, Lebanon
| | - Mohamad Y Fares
- Department of Orthopedics, Hotel Dieu de France, Saint Joseph University, Beirut, Lebanon
| | - Khaled J Saleh
- Department of Orthopedics, FAJR Scientific, Northville, MI, USA
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4
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Awad ME, Farley BJ, Mostafa G, Darwiche HF, Saleh KJ. The risk of hospital readmission, revision, and intra- and postoperative complications between direct anterior versus posterior approaches in primary total hip arthroplasty: a stratified meta-analysis and a probability based cost projection. Hip Int 2023; 33:442-462. [PMID: 35437055 DOI: 10.1177/11207000211066454] [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] [Indexed: 02/04/2023]
Abstract
INTRODUCTION This study presents stratified meta-analysis and projected cost per case analysis of direct anterior approach (DAA) versus posterior approach (PA) in total hip arthroplasty (THA) to determine the best surgical approach and guarantee hip joint longevity. METHODS Several online databases were searched for clinical trials comparing DAA and PA in primary THA. The stratified analysis was conducted to test for confounding and biases across the different types of included trials. The average cost and probability were used to determine projected added costs of medical and surgical management for complications. RESULTS 30 clinical trials included 11,562 patients who underwent THA. Almost 50% of these patients performed DAA. As compared to PA, both non-stratified and stratified analyses demonstrated that DAA has a significant higher incidence of the overall intra- and postoperative complications (non-stratified, OR 1.64; p = 0.003) (stratified, OR 4.12; p = 0.005), nerve injury (non-stratified, OR 22.0; p < 0.00001) (stratified, OR 0.28; p < 0.00001), higher rate of revision surgery (non-stratified; OR 1.54; p = 0.01) (stratified, OR 7.37; p = 0.006), and higher incidence of surgical wound complications (non-stratified; OR 1.67; p = 0.002) as compared to PA following primary THA. In addition, DAA demonstrated higher trends of incidence (non-statistically significant) of femur fracture (Non-stratified, OR 1.32, p = 0.10) and thrombo-embolic complications (Retrospective studies, OR 1.39, p = 0.69). However, PA demonstrated higher trends of incidence (non-statistically significant) of hip joint dislocation, as compared to DAA. (Stratified RCTs, OR 0.63, p = 0.65]. Collectively, this amounts a $421,068.68 surplus in DAA complication costs. CONCLUSIONS PA may provide a more lucrative, safer approach to those undergoing THA given its comparable postoperative outcomes, reduced complication rates, and lower overall cost relative to DAA.
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Affiliation(s)
- Mohamed E Awad
- Resident Research Partnership, Detroit, MI, USA
- Michigan State University, College of Osteopathic Medicine, Detroit, MI, USA
- FAJR Scientific, Northville, MI, USA
| | - Brendan J Farley
- Resident Research Partnership, Detroit, MI, USA
- FAJR Scientific, Northville, MI, USA
- Central Michigan University, College of Medicine, Mount Pleasant, MI, USA
| | - Gamal Mostafa
- Wayne State University, School of Medicine, Detroit, MI, USA
| | - Hussein F Darwiche
- Department of Orthopedic Surgery, Detroit Medical Center, Detroit, MI, USA
| | - Khaled J Saleh
- Resident Research Partnership, Detroit, MI, USA
- Michigan State University, College of Osteopathic Medicine, Detroit, MI, USA
- FAJR Scientific, Northville, MI, USA
- Central Michigan University, College of Medicine, Mount Pleasant, MI, USA
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Roldan M, Awad ME, VanAken TD, Saasouh W, Patel P, Mostafa G, Saleh KJ. Sub-chondroplasty Reduces Pain, Improves Function and Delays the Conversion to Arthroplasty in Patients with Advanced Knee Osteoarthritis: A Stratified Meta-analysis and Quality Assessment. J Surg Orthop Adv 2023; 32:65-74. [PMID: 37668640] [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: 09/06/2023]
Abstract
There is an ongoing interest in alternatives to total knee arthroplasty, as a means to delay inevitable replacement. A possible, minimally invasive, alternative is a sub-chondroplasty, involving interosseous injection of bone substitute materials such as calcium phosphate (CaPo4), platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC) or Injectable demineralized bone matrix (iDBM) into the subchondral bone. Eleven clinical trials were found, investigating the effectiveness of sub-chondroplasties performed using CaPo4, PRP, BMAC, and iDBM. A non-stratified and stratified meta-analysis of the included studies were conducted to test for confounding variables across the trials. Non-stratified analysis, regardless of injectable type, revealed a significant improvement in the average Visual Analog Scale (VAS) score and postoperative Knee Injury and Osteoarthritis Outcome Score (KOOS) in patients post sub-chondroplasty, as compared to baseline. This analysis demonstrates that the sub-chondroplasty procedure reduces pain, improves function, and has lower risk of conversion to arthroplasty. (Journal of Surgical Orthopaedic Advances 32(2):065-074, 2023).
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Affiliation(s)
- Mariana Roldan
- Universidad Autonoma de Guadalajara, School of Medicine, Zapopan, Mexico
| | - Mohamed E Awad
- NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan; Surgical Outcomes Research Institute, John D Dingell VA Medical Center, Detroit, Michigan; Michigan State University, College of Osteopathic Medicine, Detroit, Michigan
| | - Trey D VanAken
- Wayne State University, School of Medicine, Detroit, Michigan
| | - Wael Saasouh
- NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan; Wayne State University, School of Medicine, Detroit, Michigan
| | - Padmavathi Patel
- NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan; Wayne State University, School of Medicine, Detroit, Michigan
| | - Gamal Mostafa
- Wayne State University, School of Medicine, Detroit, Michigan; Surgical Outcomes Research Institute, John D Dingell VA Medical Center, Detroit, Michigan
| | - Khaled J Saleh
- Surgical Outcomes Research Institute, John D Dingell VA Medical Center, Detroit, Michigan; Michigan State University, College of Osteopathic Medicine, Detroit, Michigan
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6
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Baldawi M, Awad ME, McKelvey G, Pearl AD, Mostafa G, Saleh KJ. Neuraxial Anesthesia Significantly Reduces 30-Day Venous Thromboembolism Rate and Length of Hospital Stay in Primary Total Hip Arthroplasty: A Stratified Propensity Score-Matched Cohort Analysis. J Arthroplasty 2023; 38:108-116. [PMID: 35843379 DOI: 10.1016/j.arth.2022.07.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND General anesthesia (GA) has been the commonly used protocol for total hip arthroplasty (THA); however, neuraxial anesthesia (NA) has been increasingly performed. Our purpose was to compare NA and GA for 30-day postoperative outcomes in United States veterans undergoing primary THA. METHODS A large veteran's database was utilized to identify patients undergoing primary THA between 1999 and 2019. A total of 6,244 patients had undergone THA and were included in our study. Of these, 44,780 (79.6%) had received GA, and 10,788 (19.2%) had received NA. Patients receiving NA or GA were compared for 30-day mortalities, cardiovascular, respiratory, and renal complications, and wound infections and hospital lengths of stay (LOS). Propensity score matching, multivariate regression analyses, and subgroup analyses by American Society of Anesthesiology classification were performed to control for selection bias and patient baseline characteristics. RESULTS Upon propensity-adjusted multivariate analyses, NA was associated with decreased risks for deep venous thrombosis (odds ratio [OR] = 0.63; 95% CI = 0.4-0.9; P = .02), any respiratory complication (OR = 0.63; 95% CI = 0.5-0.9; P = .003), unplanned reintubation (OR = 0.51; 95% CI = 0.3-0.9; P = .009), and prolonged LOS (OR = 0.78; 95% CI = 0.72-0.84; P < .001). Subgroup analyses by American Society of Anesthesiology classes showed NA decreased 30-day venous thromboembolism rate in low-risk (class I/II) patients and decreased respiratory complications in high-risk (class III/IV) patients. CONCLUSION Using a patient cohort obtained from a large national database, NA was associated with reduced risk of 30-day adverse events compared to GA in patients undergoing THA. Postoperative adverse events were decreased with NA administration with similar decreases observed across all patient preoperative risk levels. NA was also associated with a significant decrease in hospital LOS.
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Affiliation(s)
- Mohanad Baldawi
- NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan; Department of Surgery, John D. Dingell VA Medical Center, Detroit, Michigan
| | - Mohamed E Awad
- NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan; Michigan State University College of Osteopathic Medicine, Detroit, Michigan; Wayne State University, School of Medicine, Detroit, Michigan
| | - George McKelvey
- NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan; Department of Surgery, John D. Dingell VA Medical Center, Detroit, Michigan
| | - Adam D Pearl
- Department of Surgery, John D. Dingell VA Medical Center, Detroit, Michigan; Wayne State University, School of Medicine, Detroit, Michigan
| | - Gamal Mostafa
- Department of Surgery, John D. Dingell VA Medical Center, Detroit, Michigan; Wayne State University, School of Medicine, Detroit, Michigan
| | - Khaled J Saleh
- Department of Surgery, John D. Dingell VA Medical Center, Detroit, Michigan; Michigan State University College of Osteopathic Medicine, Detroit, Michigan
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7
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Farley BJ, Awad ME, Anderson P, Esseili AS, Hruska J, Mostafa G, Saleh KJ. Opioid-Related Genetic Polymorphisms of Cytochrome P450 Enzymes after Total Joint Arthroplasty: A Focus on Drug-Drug-Gene Interaction with Commonly Coprescribed Medications. Orthop Clin North Am 2022; 53:361-375. [PMID: 36208880 DOI: 10.1016/j.ocl.2022.06.001] [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] [Indexed: 02/02/2023]
Abstract
Pharmacogenomic testing, together with the early detection of drug-drug-gene interactions (DDGI) before initiating opioids, can improve the selection of dosage and reduce the risk of adverse drug interactions and therapeutic failures following Total Joint Arthroplasty. The variants of CYP genes can mediate DDGI. Orthopedic surgeons should become familiar with the genetic aspect of opioid use and abuse, as well as the influence of the patient genetic makeup in opioid selection and response, and polymorphic variants in pain modulation.
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Affiliation(s)
- Brendan J Farley
- FAJR Scientific, Resident Research Partnership, 9308 Hickory Ridge Rd, Suite 301, Northville, MI, 48167, USA; Department of Orthopaedic Surgery, West Virginia University, 6040 University Town Centre Dr Drive, Morgantown, WV 26501, USA
| | - Mohamed E Awad
- FAJR Scientific, Resident Research Partnership, 9308 Hickory Ridge Rd, Suite 301, Northville, MI, 48167, USA; NorthStar Anesthesia, Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA; Michigan State University College of Osteopathic Medicine, 965 Wilson Rd, East Lansing, MI 48824, USA
| | - Paige Anderson
- FAJR Scientific, Resident Research Partnership, 9308 Hickory Ridge Rd, Suite 301, Northville, MI, 48167, USA; Cedarville University, 251 N Main St, Cedarville, OH 45314, USA
| | - Ali S Esseili
- FAJR Scientific, Resident Research Partnership, 9308 Hickory Ridge Rd, Suite 301, Northville, MI, 48167, USA; University of Michigan, 4901 Evergreen Rd, Dearborn, MI 48128, USA
| | - Justin Hruska
- NorthStar Anesthesia, Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA; Department of Anesthesiology, Wayne State University- Detroit Medical Center, 4201 St Antoine Street, Detroit, MI, 48201, USA
| | - Gamal Mostafa
- Wayne State University, School of Medicine, 3990 John R St, Detroit, MI 48201, USA
| | - Khaled J Saleh
- FAJR Scientific, Resident Research Partnership, 9308 Hickory Ridge Rd, Suite 301, Northville, MI, 48167, USA; Michigan State University College of Osteopathic Medicine, 965 Wilson Rd, East Lansing, MI 48824, USA; Department of Surgery, John D. Dingell VA Medical Center, 4646 John R St, Detroit, MI 48201, USA..
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8
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Irfan FB, Minetti R, Telford B, Ahmed FS, Syed AY, Hollon N, Brauman SC, Cunningham W, Awad ME, Saleh KJ, Waljee AK, Brusselaers N. Coronavirus pandemic in the Nordic countries: Health policy and economy trade-off. J Glob Health 2022; 12:05017. [PMID: 35932219 PMCID: PMC9356530 DOI: 10.7189/jogh.12.05017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Countries making up the Nordic region – Denmark, Finland, Iceland, Norway, and Sweden – have minimal socioeconomic, cultural, and geographical differences between them, allowing for a fair comparative analysis of the health policy and economy trade-off in their national approaches towards mitigating the impact of the COVID-19 pandemic. Methods This study utilized publicly available COVID-19 data of the Nordic countries from January 2020 to January 3, 2021. COVID-19 epidemiology, public health and health policy, health system capacity, and macroeconomic data were analysed for each Nordic country. Joinpoint regression analysis was performed to identify changes in temporal trends using average monthly percent change (AMPC) and average weekly percent change (AWPC). Results Sweden’s health policy, being by far the most relaxed response to COVID-19, was found to have the largest COVID-19 incidence and mortality, and the highest AWPC increases for both indicators (13.5, 95% CI = 5.6, 22.0, P < 0.001; 6.3, 95% CI = 3.5, 9.1, P < 0.001). Denmark had the highest number of COVID-19 tests per capita, consistent with their approach of increased testing as a preventive strategy for disease transmission. Iceland had the second-highest number of tests per capita due to their mass-testing, contact tracing, quarantine and isolation response. Only Norway had a significant increase in unemployment (AMPC = 2.8%, 95% CI = 0.7-4.9, P < 0.009) while the percentage change in real Gross Domestic Product (GDP) was insignificant for all countries. Conclusions There was no trade-off between public health policy and economy during the COVID-19 pandemic in the Nordic region. Sweden’s relaxed and delayed COVID-19 health policy response did not benefit the economy in the short term, while leading to disproportionate COVID-19 hospitalizations and mortality.
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Affiliation(s)
- Furqan B Irfan
- Institute of Global Health, Michigan State University, East Lansing, Michigan, USA.,Department of Neurology and Ophthalmology, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Raoul Minetti
- Department of Economics, Michigan State University, Marshall-Adams Hall, East Lansing, Michigan, USA
| | - Ben Telford
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Fahad S Ahmed
- Department of Pathology, Wayne State University, Detroit, Michigan, USA
| | | | - Nick Hollon
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Seth C Brauman
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - William Cunningham
- Institute of Global Health, Michigan State University, East Lansing, Michigan, USA
| | - Mohamed E Awad
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Khaled J Saleh
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Akbar K Waljee
- University of Michigan Medical School, Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA.,University of Michigan Medical School, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Ann Arbor, Michigan, USA
| | - Nele Brusselaers
- Centre for Translational Microbiome Research, Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden.,Global Health Institute, Antwerp University, Antwerpen, Wilrijk, Belgium
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9
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Crespi Z, Hasan AI, Pearl A, Ismail A, Awad ME, Irfan FB, Jaffar M, Patel P, Saleh KJ. Current Guidelines and Practice Recommendations to Prevent Hospital-Acquired Conditions After Major Orthopaedic Surgeries. JBJS Rev 2022; 10:01874474-202203000-00012. [PMID: 35290253 DOI: 10.2106/jbjs.rvw.21.00152] [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: 11/14/2022]
Abstract
» In 2016, a total of 48,771 hospital-acquired conditions (HACs) were reported in U.S. hospitals. These incidents resulted in an excess cost of >$2 billion, which translates to roughly $40,000 per patient with an HAC. » Current guidelines for the prevention of venous thromboembolism and surgical site infection consist primarily of antithrombotic prophylaxis and antiseptic technique, respectively. » The prevention of catheter-associated urinary tract infection (CA-UTI) and in-hospital falls and trauma is done best via education. In the case of CA-UTI, this consists of training staff about the indications for catheters and their timely removal when they are no longer necessary, and in the case of in-hospital falls and trauma, advising the patient and family about the patient's fall risk and communicating the fall risk to the health-care team. » Blood incompatibility is best prevented by implementation of a pretransfusion testing protocol. Pressure ulcers can be prevented via patient positioning, especially during surgery, and via postoperative skin checks.
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Affiliation(s)
- Zachary Crespi
- College of Medicine, Central Michigan University, Mount Pleasant, Michigan
| | - Ahmad I Hasan
- School of Medicine, Wayne State University, Detroit, Michigan.,FAJR Scientific, Northville, Michigan
| | - Adam Pearl
- School of Medicine, Wayne State University, Detroit, Michigan
| | - Aya Ismail
- FAJR Scientific, Northville, Michigan.,University of Michigan, Dearborn, Michigan
| | - Mohamed E Awad
- FAJR Scientific, Northville, Michigan.,NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan.,Michigan State University-College of Osteopathic Medicine, Detroit, Michigan.,Department of Surgery, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
| | - Furqan B Irfan
- Michigan State University-College of Osteopathic Medicine, Detroit, Michigan
| | - Muhammed Jaffar
- NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan.,Department of Surgery, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
| | - Padmavathi Patel
- NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan.,Department of Surgery, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
| | - Khaled J Saleh
- FAJR Scientific, Northville, Michigan.,Michigan State University-College of Osteopathic Medicine, Detroit, Michigan.,Department of Surgery, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
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10
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Elhage KG, Awad ME, Irfan FB, Lumbley J, Mostafa G, Saleh KJ. Closed‐incision
negative pressure therapy at −125
mmHg
significantly reduces surgical site complications following total hip and knee arthroplasties: A stratified meta‐analysis of randomized controlled trials. Health Sci Rep 2022; 5:e425. [PMID: 35229037 PMCID: PMC8865069 DOI: 10.1002/hsr2.425] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 12/13/2022] Open
Abstract
Background Closed‐incision negative pressure wound therapy (ciNPT) has shown promising effects for managing infected wounds. This meta‐analysis explores the current state of knowledge on ciNPT in orthopedics and addresses whether ciNPT at −125 mmHg or −80 mmHg or conventional dressing reduces the incidence of surgical site complications in hip and knee arthroplasty. Methods This meta‐analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta‐analysis (PRISMA) guidelines and Cochrane Handbook. Prospective randomized controlled trials (RCTs) with ciNPT use compared to conventional dressings following hip and knee surgeries were considered for inclusion. Non‐stratified and stratified meta‐analyses of six RCTs were conducted to test for confounding and biases. A P value less than .05 was considered statistically significant. Results The included six RCTs have 611 patients. Total hip and knee arthroplasties were performed for 51.7% and 48.2% of the included population, respectively. Of 611 patients, conventional dressings were applied in 315 patients and 296 patients received ciNPT. Two ciNPT systems have been used across the six RCTs; PREVENA Incision Management System (−125 mmHg) (63.1%) and PICO dressing (−80 mmHg) (36.8%). The non‐stratified analysis showed that the ciNPT system had a statistically significant, lower risk of persistent wound drainage as compared to conventional dressing following total hip and knee arthroplasties (OR = 0.28; P = .002). There was no difference between ciNPT and conventional dressings in terms of wound hematoma, blistering, seroma, and dehiscence. The stratified meta‐analysis indicated that patients undergoing treatment with high‐pressure ciNPT (120 mmHg) displayed significantly fewer overall complications and persistent wound drainage (P = .00001 and P = .002, respectively) when compared to low‐pressure ciNPT (80 mmHg) and conventional dressings. In addition, ciNPT is associated with shorter hospital stays. (P = .005). Conclusion When compared to conventional wound dressing and −80 mmHg ciNPT, the use of −125 mmHg ciNPT is recommended in patients undergoing total joint arthroplasty.
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Affiliation(s)
- Kareem G. Elhage
- FAJR Scientific Northville Michigan 48167 USA
- Wayne State University, School of Medicine Detroit Michigan USA
| | - Mohamed E. Awad
- FAJR Scientific Northville Michigan 48167 USA
- NorthStar Anesthesia‐Detroit Medical center Detroit Michigan USA
- Michigan State University, College of Osteopathic Medicine Detroit Michigan USA
| | - Furqan B. Irfan
- Michigan State University, College of Osteopathic Medicine Detroit Michigan USA
| | - Joshua Lumbley
- NorthStar Anesthesia‐Detroit Medical center Detroit Michigan USA
| | - Gamal Mostafa
- Wayne State University, School of Medicine Detroit Michigan USA
- Surgical Outcomes Research Institute, John D. Dingell VA Medical Center Detroit Michigan USA
| | - Khaled J. Saleh
- FAJR Scientific Northville Michigan 48167 USA
- Michigan State University, College of Osteopathic Medicine Detroit Michigan USA
- Surgical Outcomes Research Institute, John D. Dingell VA Medical Center Detroit Michigan USA
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11
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Crespi Z, Ismail A, Awad ME, Hasan AI, Irfan FB, Jaffar M, El-Othmani MM, Saleh KJ. Hospital-Acquired Conditions: A Review of Classical and Novel Risk Factors Following Total Hip and Knee Arthroplasties. JBJS Rev 2021; 9:01874474-202107000-00006. [PMID: 34270501 DOI: 10.2106/jbjs.rvw.20.00240] [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: 11/14/2022]
Abstract
» In 2016, a total of 48,771 hospital-acquired conditions (HACs) were reported in U.S. hospitals. These incidents resulted in an excess cost of >$2 billion, which translates to roughly $41,000 per patient per HAC. » In the settings of total hip arthroplasty (THA) and total knee arthroplasty (TKA), increased age, a body mass index of >35 kg/m2, male sex, diabetes mellitus, electrolyte disturbances, and a history of anemia increase the likelihood of surgical site infections. » Institution-specific (surgical) risk factors such as increased tourniquet time, an operative time of >130 minutes, bilateral procedures, a femoral nerve block, and general anesthesia increase the risk of HACs in the settings of THA and TKA.
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Affiliation(s)
- Zachary Crespi
- Central Michigan University College of Medicine, Mount Pleasant, Michigan
| | - Aya Ismail
- University of Michigan, Dearborn, Michigan
| | - Mohamed E Awad
- FAJR Scientific, Northville, Michigan.,Saleh Medical Innovations Consulting, PLLC, Northville, Michigan.,NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan.,Michigan State University, College of Osteopathic Medicine, Detroit, Michigan
| | - Ahmad I Hasan
- FAJR Scientific, Northville, Michigan.,Saleh Medical Innovations Consulting, PLLC, Northville, Michigan.,Wayne State University School of Medicine, Detroit, Michigan
| | - Furqan B Irfan
- Michigan State University, College of Osteopathic Medicine, Detroit, Michigan
| | - Muhammad Jaffar
- NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan
| | | | - Khaled J Saleh
- FAJR Scientific, Northville, Michigan.,Saleh Medical Innovations Consulting, PLLC, Northville, Michigan.,Michigan State University, College of Osteopathic Medicine, Detroit, Michigan
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12
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Awad ME, Farley BJ, Mostafa G, Saleh KJ. Direct anterior approach has short-term functional benefit and higher resource requirements compared with the posterior approach in primary total hip arthroplasty : a meta-analysis of functional outcomes and cost. Bone Joint J 2021; 103-B:1078-1087. [PMID: 34058867 DOI: 10.1302/0301-620x.103b6.bjj-2020-1271.r1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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] [Indexed: 11/05/2022]
Abstract
AIMS It has been suggested that the direct anterior approach (DAA) should be used for total hip arthroplasty (THA) instead of the posterior approach (PA) for better early functional outcomes. We conducted a value-based analysis of the functional outcome and associated perioperative costs, to determine which surgical approach gives the better short-term outcomes and lower costs. METHODS This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol and the Cochrane Handbook. Several online databases were searched. Non-stratified and stratified meta-analyses were conducted to test the confounding biases in the studies which were included. The mean cost and probability were used to determine the added costs of perioperative services. RESULTS The DAA group had significantly longer operating times (p < 0.001), reduced length of hospital stay by a mean of 13.4 hours (95% confidence interval (CI) 9.12 to 18; p < 0.001), and greater blood loss (p = 0.030). The DAA group had significantly better functional outcome at three (p < 0.001) and six weeks (p = 0.006) postoperatively according to the Harris Hip Score (HHS). However, there was no significant difference between the groups for the HHS at six to eight weeks (p = 0.230), 12 weeks (p = 0.470), six months (p = 0.740), and one year (p = 0.610), the 12-Item Short Form Survey (SF-12) physical score at six weeks (p = 0.580) and one year (p = 0.360), SF-12 mental score at six weeks (p = 0.170) and one year (p = 0.960), and University of California and Los Angeles (UCLA) activity scale at 12 weeks (p = 0.250). The mean non-stratified and stratified difference in costs for the operating theatre time and blood transfusion were $587.57 (95% CI 263.83 to 1,010.29) to $887.04 (95% CI 574.20 to 1,298.88) and $248.38 (95% CI 1,003.40 to 1,539.90) to $1,162.41 (95% CI 645.78 to 7,441.30), respectively, more for the DAA group. However, the mean differences in costs for the time in hospital were $218.23 and $192.05, respectively, less for the DAA group. CONCLUSION The use of the DAA, rather than the PA, in THA has earlier benefits for function and pain. However, these are short-lasting, with no significant differences seen at later intervals. In addition the limited benefits were obtained with higher cumulative costs for DAA. Cite this article: Bone Joint J 2021;103-B(6):1078-1087.
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Affiliation(s)
- Mohamed E Awad
- Resident Research Partnership, Detroit, Michigan, USA.,NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan, USA.,School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Brendan J Farley
- Resident Research Partnership, Detroit, Michigan, USA.,College of Medicine, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Gamal Mostafa
- School of Medicine, Wayne State University, Detroit, Michigan, USA.,Surgical Outcomes Research Institute, Detroit, Michigan, USA
| | - Khaled J Saleh
- Resident Research Partnership, Detroit, Michigan, USA.,Surgical Outcomes Research Institute, Detroit, Michigan, USA.,College of Osteopathic Medicine, Michigan State University, Detroit, Michigan, USA
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13
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Shahait A, Mesquita-Neto JWB, Hasnain MR, Baldawi M, Girten K, Weaver D, Saleh KJ, Gruber SA, Mostafa G. Outcomes of cholecystectomy in US veterans with cirrhosis: Predicting outcomes using nomogram. Am J Surg 2020; 221:538-542. [PMID: 33358373 DOI: 10.1016/j.amjsurg.2020.12.031] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/16/2020] [Accepted: 12/17/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study examines the outcomes of open and laparoscopic cholecystectomy (OC/LC) in veterans with cirrhosis and develops a nomogram to predict outcomes. METHODS We analyzed the Veterans Affairs Surgical Quality Improvement Program to identify all patients with cirrhosis and ascites who underwent cholecystectomy from 2008 to 2015. Univariate and multivariate regression were used to identify predictors of morbidity and mortality. A predictive nomogram was constructed and internally validated. RESULTS A total of 349 patients were identified. Overall, complications occurred in 18.7% of patients, and mortality was 3.8%. LC was performed in 58.9%, and 19.2% were preformed emergently. Overall, Model for End-Stage Liver Disease score was an independent factor of morbidity and mortality, while laparoscopic approach had a protective effect on morbidity. CONCLUSIONS Although cholecystectomy is a high-risk operation in cirrhotic veterans, LC may have favorable outcomes than OC in selected patients. An easy-to-use nomogram to predict morbidity and mortality for cirrhotic patients undergoing cholecystectomy is proposed.
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Affiliation(s)
- Awni Shahait
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI, USA; Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA.
| | - Jose Wilson B Mesquita-Neto
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI, USA; Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA
| | | | - Mohanad Baldawi
- Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA
| | - Kara Girten
- Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA
| | - Donald Weaver
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI, USA; Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA
| | - Khaled J Saleh
- Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA
| | - Scott A Gruber
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI, USA; Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA
| | - Gamal Mostafa
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI, USA; Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA
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14
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Shahait AD, Alghanem L, Cmorej P, Tracy W, Hasnain MR, Baldawi M, Girten K, Weaver D, Saleh KJ, Gruber SA, Mostafa G. Postoperative outcomes of ventral hernia repair in veterans. Surgery 2020; 169:603-609. [PMID: 33077198 DOI: 10.1016/j.surg.2020.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/30/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Ventral hernia repair is a common procedure with reported 15% to 37% morbidity and 0.3% to 1.4% mortality rates. This study examines the 30-day morbidity and mortality of open and laparoscopic ventral hernia repair in veterans, along with the impact of body mass index on these outcomes. METHODS The Veterans Affairs Surgical Quality Improvement Program was queried for all ventral hernia repairs during the period 2008 to 2015. In this retrospective analysis, we compared outcomes of open ventral hernia repair versus laparoscopic ventral hernia repair and among different body mass index classes. RESULTS A total of 19,883 patients were identified (92.6% male, mean age 59.7, 53.1% obese, and 71.6% with American Society of Anesthesiologists class ≥III). There were 95 (0.5%) mortalities, and complications occurred in 1,289 (6.5%) patients. Open ventral hernia repair was performed in 60.2%; 14.5% were recurrent, and 3.3% were performed as an emergency operation. When compared with open ventral hernia repair, the laparoscopic ventral hernia repair group had higher mean body mass index, less patients with American Society of Anesthesiologists class ≥III, fewer emergency operations, longer operative time, less complications, decreased mortality, and shorter duration of stay. Body mass index 35.00 to 49.99 was predictive of overall complications in the open ventral hernia repair group. CONCLUSION Ventral hernia repair can be performed in the veteran population with outcomes comparable to those in the private sector. Morbid obesity has a negative impact on ventral hernia repair outcomes that is most prominent following open surgery. Laparoscopic ventral hernia repair may offer superior outcomes when compared to open ventral hernia repair and may be considered.
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Affiliation(s)
- Awni D Shahait
- Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI; Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | - Lana Alghanem
- The Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Peter Cmorej
- Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI; Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | - William Tracy
- Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | | | - Mohanad Baldawi
- Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | - Kara Girten
- Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | - Donald Weaver
- Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI
| | - Khaled J Saleh
- Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | - Scott A Gruber
- Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI; Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | - Gamal Mostafa
- Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI; Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI.
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15
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Kong J, Shahait A, Girten K, Baldawi M, Hasnain MR, Saleh KJ, Gruber SA, Weaver D, Mostafa G. Recent trends in cholecystectomy in US veterans. Surg Endosc 2020; 35:5558-5566. [PMID: 33025254 DOI: 10.1007/s00464-020-08056-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION We hypothesize that the recent trend in performing cholecystectomy in US Veterans shows wide adoption of the laparoscopic technique and improvement in the outcome following both laparoscopic (LC) and open cholecystectomy (OC). This study utilizes the Veterans Affairs Surgical Quality Improvement Program database to examine the status and outcome of cholecystectomy. METHODS A retrospective review of veterans who underwent cholecystectomy between 2008 and 2015 was performed. Data analysis included patient demographics, operations, and postoperative outcomes. Cochran-Armitage trend analysis was used to assess significant changes in outcome over the study period. p ≤ 0.05 was considered significant. RESULTS A total of 40,722 patients (average age of 61 years) were included in the study (males 85.6%). LC was performed in the majority of patients (86.4%). Patients in the OC group (13.6%) were more likely to have advanced age (≥ 65 years) (47.6% vs 32.0%, p < 0.001) and higher ASA class (III-V) (81.9% vs 65.4%, p < 0.001) than those in the LC group. Compared with LC, OC had higher mortality rates at 30 days (1.3% vs 0.3%; OR = 1.6, p = 0.03), 3 months (2.6% vs 0.7%; OR = 1.7, p < 0.001), 6 months (3.9% vs 1.1%; OR = 1.5, p < 0.001) and 1 year (5.7% vs 2.0%; OR = 1.5, p < 0.001); higher rates of morbidity, including pneumonia (OR = 1.9, p < 0.001), deep venous thrombosis (OR = 2.4, p = 0.02), reoperation (OR = 1.8, p < 0.001), and superficial (OR = 4.9, p < 0.001) and deep (OR = 1.5, p = 0.01) surgical site infections; and a longer length of stay (6.5 days vs 2.6 days, p < 0.001). Trend analysis showed a significant decrease in both mortality (p = 0.02) and morbidity (p < 0.001) for LC over the study period, but no improvement in mortality (p = 0.35) and a only a minimal improvement in morbidity (p = 0.04) for OC. CONCLUSION In the recent era, LC has been widely performed in the VA with significant improvement in outcome. Efforts are needed to adopt alternative approaches to planned OC and to improve postoperative outcomes.
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Affiliation(s)
- Joshua Kong
- Michael and Marian Ilitch Department of Surgery, Wayne State University/Detroit Medical Center, 6C, University Health Center, 4201 St. Antoine, Detroit, MI48201, USA.,Department of Surgery, John D. Dingell Veteran Affairs Medical Center, Detroit, MI, 48201, USA
| | - Awni Shahait
- Michael and Marian Ilitch Department of Surgery, Wayne State University/Detroit Medical Center, 6C, University Health Center, 4201 St. Antoine, Detroit, MI48201, USA.,Department of Surgery, John D. Dingell Veteran Affairs Medical Center, Detroit, MI, 48201, USA
| | - Kara Girten
- Department of Surgery, John D. Dingell Veteran Affairs Medical Center, Detroit, MI, 48201, USA
| | - Mohanad Baldawi
- Department of Surgery, John D. Dingell Veteran Affairs Medical Center, Detroit, MI, 48201, USA
| | - Mustafa Rashad Hasnain
- Department of Surgery, John D. Dingell Veteran Affairs Medical Center, Detroit, MI, 48201, USA
| | - Khaled J Saleh
- Department of Surgery, John D. Dingell Veteran Affairs Medical Center, Detroit, MI, 48201, USA
| | - Scott A Gruber
- Michael and Marian Ilitch Department of Surgery, Wayne State University/Detroit Medical Center, 6C, University Health Center, 4201 St. Antoine, Detroit, MI48201, USA.,Department of Surgery, John D. Dingell Veteran Affairs Medical Center, Detroit, MI, 48201, USA
| | - Donald Weaver
- Michael and Marian Ilitch Department of Surgery, Wayne State University/Detroit Medical Center, 6C, University Health Center, 4201 St. Antoine, Detroit, MI48201, USA
| | - Gamal Mostafa
- Michael and Marian Ilitch Department of Surgery, Wayne State University/Detroit Medical Center, 6C, University Health Center, 4201 St. Antoine, Detroit, MI48201, USA. .,Department of Surgery, John D. Dingell Veteran Affairs Medical Center, Detroit, MI, 48201, USA.
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16
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Hijazi A, Padela MT, Sayeed Z, Hammad A, Devole K, Frush T, Mostafa G, Yassir WK, Saleh KJ. Review article: Patient characteristics that act as risk factors for intraoperative complications in hip, knee, and shoulder arthroplasties. J Orthop 2019; 17:193-197. [PMID: 31879503 DOI: 10.1016/j.jor.2019.06.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 04/26/2019] [Accepted: 06/16/2019] [Indexed: 11/25/2022] Open
Abstract
The number of annual THA's, TKA's, and TSA's is set to increase significantly by the year 2030, making it imperative to understand the risks for negative outcomes in these procedures. While research has studied the patient risk factors for perioperative and postoperative complications, there has been relatively little research for intraoperative complications. After a thorough literature review, the most supported finding was that patients with a BMI >30 had significantly more intraoperative blood loss than those with a BMI <30. All other relationships between patient risk factors and intraoperative complications of interest were inadequately studied.
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Affiliation(s)
- Adel Hijazi
- John D. Dingell Veteran Affairs Medical Center, Detroit, MI, USA
| | - Muhammad Talha Padela
- John D. Dingell Veteran Affairs Medical Center, Detroit, MI, USA.,FAJR Scientific, Detroit, MI, USA.,Resident Research Partnership, Detroit, MI, USA.,Chicago Medical School, Department of Orthopaedic Surgery, Rosalind Franklin University, North Chicago, IL, USA.,Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI, USA
| | - Zain Sayeed
- FAJR Scientific, Detroit, MI, USA.,Resident Research Partnership, Detroit, MI, USA.,Chicago Medical School, Department of Orthopaedic Surgery, Rosalind Franklin University, North Chicago, IL, USA.,Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI, USA
| | - Aws Hammad
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI, USA
| | - Kamela Devole
- John D. Dingell Veteran Affairs Medical Center, Detroit, MI, USA.,FAJR Scientific, Detroit, MI, USA
| | - Todd Frush
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI, USA
| | - Gamal Mostafa
- John D. Dingell Veteran Affairs Medical Center, Detroit, MI, USA.,FAJR Scientific, Detroit, MI, USA
| | | | - Khaled J Saleh
- John D. Dingell Veteran Affairs Medical Center, Detroit, MI, USA.,FAJR Scientific, Detroit, MI, USA.,Michigan State University College of Medicine, Detroit, MI, USA.,Saleh Medical Innovations PLLC, Northville, MI, USA
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17
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El-Othmani MM, Sayeed Z, Ramsey JA, Abaab L, Little BE, Saleh KJ. The Joint Utilization Management Program-Implementation of a Bundle Payment Model and Comparison Between Year 1 and 2 Results. J Arthroplasty 2019; 34:2532-2537. [PMID: 31375287 DOI: 10.1016/j.arth.2019.06.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 02/02/2017] [Revised: 06/15/2019] [Accepted: 06/18/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Health care spending is projected to increase throughout the next decade alongside the number of total joint arthroplasties (TJAs) performed. Such growth places significant financial burden on the economic system. To address these concerns, Bundled Payments for Care Improvement (BPCI) is becoming a favorable reimbursement model. The aim of this study is to present the outcomes with BPCI model focused on the post-acute care (PAC) phase and compare the outcomes between years 1 and 2 of implementation. METHODS The Joint Utilization Management Program (JUMP) was implemented in January 2014. Inclusion criteria were Medicare patients undergoing primary unilateral in-patient TJA procedures, outpatient procedures that resulted in an in-hospital admission, and trauma episodes that required TJA. Scorecards monitoring surgeons' performance and tracking length of stay (LOS) in the PAC setting were established. The data generated from these scorecards guided percentage sum-allocation from the total gain-shared sum among the participating providers. RESULTS A total of 683 JUMP patients were assessed over two years. PAC utilization decreased between 2014 and 2015. The average LOS was longer in year 1 than year 2 (4.50 vs 3.19 days). In-patient rehabilitation (IPR) decreased from 6.45% to 3.22%, with a decrease in IPR average LOS of 1.47 days. The rate of 30-day readmission was lower for JUMP patients in 2015 than 2014 (8.77% vs 10.56%), with day of readmission being earlier (11.91 days vs 13.71 days) in 2014. CONCLUSION Under the BPCI program, our experience with the JUMP model demonstrates higher efficiency of care in the PAC setting through reduced LOS, IPR admission rates, and 30-day readmission rate.
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Affiliation(s)
- Mouhanad M El-Othmani
- Musculoskeletal Institute of Excellence, Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, MI
| | - Zain Sayeed
- Musculoskeletal Institute of Excellence, Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, MI
| | - J'nise A Ramsey
- Rehab Institute of Michigan, Department of Rehabilitation, Detroit Medical Center, Detroit, MI
| | - Leila Abaab
- Musculoskeletal Institute of Excellence, Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, MI
| | - Bryan E Little
- Musculoskeletal Institute of Excellence, Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, MI
| | - Khaled J Saleh
- Musculoskeletal Institute of Excellence, Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, MI
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18
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Fayaz HC, Smith RM, Ebrahimzadeh MH, Pape HC, Parvizi J, Saleh KJ, Stahl JP, Zeichen J, Kellam JF, Mortazavi J, Rajgopal A, Dahiya V, Zinser W, Reznik L, Shubnyakov I, Pećina M, Jupiter JB. Improvement of Orthopedic Residency Programs and Diversity: Dilemmas and Challenges, an International Perspective. Arch Bone Jt Surg 2019; 7:384-396. [PMID: 31448318 PMCID: PMC6686073] [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] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/04/2018] [Indexed: 06/10/2023]
Abstract
BACKGROUND To date, little has been published comparing the structure and requirements of orthopedic training programs across multiple countries. The goal of this study was to summarize and compare the characteristics of orthopedic training programs in the U.S.A., U.K., Canada, Australia, Germany, India, China, Saudi Arabia, Russia and Iran. METHODS We communicated with responders using a predetermined questionnaire regarding the national orthopedic training program requirements in each respondent's home country. Specific items of interest included the following: the structure of the residency program, the time required to become an orthopedic surgeon, whether there is a log book, whether there is a final examination prior to becoming an orthopedic surgeon, the type and extent of faculty supervision, and the nature of national in-training written exams and assessment methods. Questionnaire data were augmented by reviewing each country's publicly accessible residency training documents that are available on the web and visiting the official website of the main orthopedic association of each country. RESULTS The syllabi consist of three elements: clinical knowledge, clinical skills, and professional skills. The skill of today's trainees predicts the quality of future orthopedic surgeons. The European Board of Orthopedics and Traumatology (EBOT) exam throughout the European Union countries should function as the European board examination in orthopedics. We must standardize many educational procedures worldwide in the same way we standardized patient safety. CONCLUSION Considering the world's cultural and political diversity, the world is nearly unified in regards to orthopedics. The procedures (structure of the residency programs, duration of the residency programs, selection procedures, using a log book, continuous assessment and final examination) must be standardized worldwide, as implemented for patient safety. To achieve this goal, we must access and evaluate more information on the residency programs in different countries and their needs by questioning them regarding what they need and what we can do for them to make a difference.
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Affiliation(s)
- Hangama C Fayaz
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Raymond M Smith
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Mohammad H Ebrahimzadeh
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Hans-Christoph Pape
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Javad Parvizi
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Khaled J Saleh
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Jens-Peter Stahl
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Johannes Zeichen
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - James F Kellam
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Javad Mortazavi
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Ashok Rajgopal
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Vivek Dahiya
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Wolfgang Zinser
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Leonid Reznik
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Igor Shubnyakov
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Marko Pećina
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Jesse B Jupiter
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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19
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Sayeed Z, Anoushiravani AA, Simha S, Padela MT, Schafer P, Awad ME, Darwiche HF, Saleh KJ. Markers for Malnutrition and BMI Status in Total Joint Arthroplasty and Pharmaconutrient Therapy. JBJS Rev 2019; 7:e3. [PMID: 31094890 DOI: 10.2106/jbjs.rvw.18.00056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Zain Sayeed
- Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, Michigan.,Resident Research Partnership, Detroit, Michigan.,Department of Orthopaedic Surgery, Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois.,Fajr Scientific, Detroit, Michigan
| | | | | | - Muhammad Talha Padela
- Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, Michigan.,Resident Research Partnership, Detroit, Michigan.,Department of Orthopaedic Surgery, Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois.,Fajr Scientific, Detroit, Michigan.,Michigan State University College of Medicine, Detroit, Michigan.,John D. Dingell Veteran Affairs Medical Center, Detroit, Michigan
| | - Patrick Schafer
- Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, Michigan
| | - Mohamed E Awad
- Resident Research Partnership, Detroit, Michigan.,Fajr Scientific, Detroit, Michigan.,Michigan State University College of Medicine, Detroit, Michigan.,John D. Dingell Veteran Affairs Medical Center, Detroit, Michigan
| | - Hussein F Darwiche
- Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, Michigan.,Resident Research Partnership, Detroit, Michigan
| | - Khaled J Saleh
- Fajr Scientific, Detroit, Michigan.,Michigan State University College of Medicine, Detroit, Michigan.,John D. Dingell Veteran Affairs Medical Center, Detroit, Michigan
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20
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Awad ME, Padela MT, Sayeed Z, El-Othmani MM, Zekaj M, Darwiche HF, Saleh KJ. Pharmacogenomic Testing for Postoperative Pain Optimization Before Total Joint Arthroplasty: A Focus on Drug-Drug-Gene Interaction with Commonly Prescribed Drugs and Prior Opioid Use. JBJS Rev 2019; 7:e2. [PMID: 31094889 DOI: 10.2106/jbjs.rvw.18.00058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mohamed E Awad
- Resident Research Partnership, Detroit, Michigan.,FAJR Scientific, Detroit, Michigan.,Michigan State University College of Osteopathic Medicine, Detroit, Michigan.,John D. Dingell VA Medical Center, Detroit, Michigan
| | - Muhammad Talha Padela
- Resident Research Partnership, Detroit, Michigan.,FAJR Scientific, Detroit, Michigan.,John D. Dingell VA Medical Center, Detroit, Michigan.,Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, Michigan.,Department of Orthopaedic Surgery, Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois
| | - Zain Sayeed
- Resident Research Partnership, Detroit, Michigan.,John D. Dingell VA Medical Center, Detroit, Michigan.,Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, Michigan.,Department of Orthopaedic Surgery, Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois
| | - Mouhanad M El-Othmani
- Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, Michigan
| | - Mark Zekaj
- Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, Michigan
| | - Hussein F Darwiche
- Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, Michigan
| | - Khaled J Saleh
- FAJR Scientific, Detroit, Michigan.,Michigan State University College of Osteopathic Medicine, Detroit, Michigan.,John D. Dingell VA Medical Center, Detroit, Michigan
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21
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Sleiman B, Sayeed Z, Padela MT, Padela AF, Bobba V, Yassir W, Frush T, Saleh KJ. Review article: Current literature on surgical checklists and handoff tools and application for orthopaedic surgery. J Orthop 2019; 16:86-90. [PMID: 30662245 DOI: 10.1016/j.jor.2018.12.006] [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: 10/13/2018] [Accepted: 12/02/2018] [Indexed: 10/27/2022] Open
Abstract
Despite the adaptation of checklists for specific surgeries being developed, there remains a lack of an available standard for an orthopaedic-specific checklist. Benefits of implementing checklists include cost-effectiveness as well as the ability to significantly reduce both mortality and complication rates in a variety of healthcare settings. The aim of this review is to analyze the evidence surrounding the effectiveness of checklists as well as recommend for the development of a standard checklist for specific orthopaedic surgeries such as total joint arthroplasty (TJA).
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Affiliation(s)
| | - Zain Sayeed
- Chicago Medical School, Department of Orthopaedic Surgery, Rosalind Franklin University, North Chicago, IL, USA.,Resident Research Partnership, Detroit, MI, USA
| | - Muhammad T Padela
- FAJR Scientific, Detroit, MI, USA.,John D. Dingell Veteran Affairs Medical Center, Detroit, MI, USA.,Chicago Medical School, Department of Orthopaedic Surgery, Rosalind Franklin University, North Chicago, IL, USA.,Resident Research Partnership, Detroit, MI, USA
| | | | - Vamsy Bobba
- Resident Research Partnership, Detroit, MI, USA
| | - Walid Yassir
- FAJR Scientific, Detroit, MI, USA.,Resident Research Partnership, Detroit, MI, USA.,DMC Children's Hospital of Michigan, Department of Orthopaedic Surgery, Detroit, MI, USA
| | - Todd Frush
- Resident Research Partnership, Detroit, MI, USA
| | - Khaled J Saleh
- FAJR Scientific, Detroit, MI, USA.,Michigan State University College of Medicine, Detroit, MI, USA.,John D. Dingell Veteran Affairs Medical Center, Detroit, MI, USA
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22
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Kurdi AJ, Voss BA, Tzeng TH, Scaife SL, El-Othmani MM, Saleh KJ. Rheumatoid Arthritis vs Osteoarthritis: Comparison of Demographics and Trends of Joint Replacement Data from the Nationwide Inpatient Sample. ACTA ACUST UNITED AC 2018; 47. [PMID: 30075040 DOI: 10.12788/ajo.2018.0050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Current literature regarding complications following total joint arthroplasty have primarily focused on patients with osteoarthritis (OA), with less emphasis on the trends and in-hospital outcomes of rheumatoid arthritis (RA) patients undergoing these procedures. The purpose of this study is to analyze the outcomes and trends of RA patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA) compared to OA patients. Data from the Nationwide Inpatient Sample from 2006 to 2011 was extracted using the International Classification of Diseases, Ninth Revision codes for patients that received a TKA or THA. Outcome measures included cardiovascular complications, cerebrovascular complications, pulmonary complications, wound dehiscence, and infection. Inpatient and hospital demographics including primary diagnosis, age, gender, primary payer, hospital teaching status, Charlson Comorbidity Index score, hospital bed size, location, and median household income were analyzed. Logistic regression analysis of OA vs RA patients with patient outcomes revealed that osteoarthritic THA candidates had lower risk for cardiovascular complications, pulmonary complications, wound dehiscence, infections, and systemic complications, compared to rheumatoid patients. There was a significantly elevated risk of cerebrovascular complication in osteoarthritic THA compared to RA THA. OA patients undergoing TKA had significantly higher risk for cardiovascular and cerebrovascular complications. There were significant decreases in mechanical wounds, infection, and systemic complications in the OA TKA patients. RA patients are at higher risk for postoperative infection, wound dehiscence, and systemic complications after TKA and THA compared to OA patients. These findings highlight the importance of preoperative medical clearance and management to optimize RA patients and improve the postoperative outcomes.
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23
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Awad ME, Padela MT, Sayeed Z, Abaab L, El-Othmani MM, Saleh KJ. Pharmacogenomics Testing for Postoperative Pain Optimization Before Total Knee and Total Hip Arthroplasty. JBJS Rev 2018; 6:e3. [PMID: 30300249 DOI: 10.2106/jbjs.rvw.17.00184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Mohamed E Awad
- Bone and Biomechanics Laboratories, Medical College of Georgia-Augusta University, Augusta, Georgia
| | - Muhammad Talha Padela
- Resident Research Partnership, Detroit, Michigan.,Departments of Orthopaedic Surgery and Sports Medicine (M.T.P., Z.S., and M.M.E.) and Anesthesiology (L.A.), Detroit Medical Center, Detroit, Michigan.,Department of Orthopaedic Surgery, Rosalind Franklin University, Chicago Medical School, North Chicago, Illinois.,Michigan Musculoskeletal Institute, Madison Heights, Michigan
| | - Zain Sayeed
- Resident Research Partnership, Detroit, Michigan.,Departments of Orthopaedic Surgery and Sports Medicine (M.T.P., Z.S., and M.M.E.) and Anesthesiology (L.A.), Detroit Medical Center, Detroit, Michigan.,Department of Orthopaedic Surgery, Rosalind Franklin University, Chicago Medical School, North Chicago, Illinois.,Michigan Musculoskeletal Institute, Madison Heights, Michigan
| | - Leila Abaab
- Departments of Orthopaedic Surgery and Sports Medicine (M.T.P., Z.S., and M.M.E.) and Anesthesiology (L.A.), Detroit Medical Center, Detroit, Michigan
| | - Mouhanad M El-Othmani
- Departments of Orthopaedic Surgery and Sports Medicine (M.T.P., Z.S., and M.M.E.) and Anesthesiology (L.A.), Detroit Medical Center, Detroit, Michigan
| | - Khaled J Saleh
- Michigan Musculoskeletal Institute, Madison Heights, Michigan
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24
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Gilbert TJ, Anoushiravani AA, Sayeed Z, Chambers MC, El-Othmani MM, Saleh KJ. Osteolysis Complicating Total Knee Arthroplasty. JBJS Rev 2018; 4:01874474-201607000-00001. [PMID: 27509327 DOI: 10.2106/jbjs.rvw.15.00081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Osteolysis is a process mounted by the host immune system that relies on several variables, including patient-related factors, type of insert material, modes of wear, and implant design. Imaging techniques such as radiography, computed tomography (CT) scans, magnetic resonance imaging (MRI), and tomosynthesis aid in diagnosing osteolysis. Surgical options for the treatment of osteolysis include the insertion of bone grafts, bone cement, and prosthetic augmentation. Although no approved pharmacological therapies for the specific treatment of osteolysis exist, the use of bisphosphonates and statins decreases the risk of osteolysis.
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Affiliation(s)
- Theodore J Gilbert
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
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25
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Lovett-Carter D, Sayeed Z, Abaab L, Pallekonda V, Mihalko W, Saleh KJ. Impact of Outpatient Total Joint Replacement on Postoperative Outcomes. Orthop Clin North Am 2018; 49:35-44. [PMID: 29145982 DOI: 10.1016/j.ocl.2017.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Total joint arthroplasty (TJA) has demonstrated tremendous benefits to patients with osteoarthritis. Health care reform has influenced surgeons to optimize TJA care pathways as well as playing a role in the formation of outpatient TJA protocols. Understanding the outcomes of outpatient TJA is imperative to surgical predicate decision making. The aim of this review is to compare outcomes of outpatient TJA patients to standard-stay inpatients. Postoperative outcomes assessed include pain, complications, readmissions, reoperation, patient satisfaction, and cost.
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Affiliation(s)
- Danielle Lovett-Carter
- Department of Orthopaedics, Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA
| | - Zain Sayeed
- Department of Orthopaedics, Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA
| | - Leila Abaab
- Department of Orthopaedics, Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA; Department of Anesthesiology - NorthStar Anesthesia, Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA
| | - Vinay Pallekonda
- Department of Anesthesiology - NorthStar Anesthesia, Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA
| | - William Mihalko
- Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering University of Tennessee, 956 Court Avenue, Memphis, TN 32116, USA
| | - Khaled J Saleh
- Department of Orthopaedics, Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA.
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26
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Sayeed Z, Abaab L, El-Othmani M, Pallekonda V, Mihalko W, Saleh KJ. Total Hip Arthroplasty in the Outpatient Setting: What You Need to Know (Part 2). Orthop Clin North Am 2018; 49:27-33. [PMID: 29145981 DOI: 10.1016/j.ocl.2017.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 02/02/2023]
Abstract
The intra- and postoperative phases of outpatient total hip arthroplasty (THA) vary by institution and surgeon. An understanding of an evidence-based approach to enhancing the intra- and postoperative phases of the care continuum is warranted to offer high-value care to outpatient candidates. This article will discuss methods for implementing successful outpatient THA protocols. Specifically it reviews information regarding anesthesia and analgesia modalities, intraoperative considerations, and postoperative rehabilitation amenable to outpatient THA.
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Affiliation(s)
- Zain Sayeed
- Department of Orthopaedics, Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA
| | - Leila Abaab
- Department of Orthopaedics, Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA; Department of Anesthesiology - NorthStar Anesthesia at Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA
| | - Mouhanad El-Othmani
- Department of Orthopaedics, Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA
| | - Vinay Pallekonda
- Department of Anesthesiology - NorthStar Anesthesia at Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA
| | - William Mihalko
- Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering University of Tennessee, 956 Court Avenue, Memphis, TN 32116, USA
| | - Khaled J Saleh
- Department of Orthopaedics, Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA.
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Abstract
Recent trends in total joint care have moved toward outpatient surgery. Total knee arthroplasty (TKA) remains a definitive management for end-stage osteoarthritis and has experienced increased utilization over the past several decades. The method by which surgeons conduct outpatient total knee procedures has yet to be fully elucidated as different institutions report different experiences from their pathways. This article will discuss current data and recommendations for implementing successful TKA and unicompartmental knee arthroplasty outpatient protocols. Specifically, this review will provide information regarding cost reduction, patient selection criteria, and preoperative medical optimization.
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Affiliation(s)
- Andrew Krause
- Department of Orthopaedics, Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA
| | - Zain Sayeed
- Department of Orthopaedics, Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA
| | - Mouhanad El-Othmani
- Department of Orthopaedics, Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA
| | - Vinay Pallekonda
- Department of Anesthesiology - NorthStar Anesthesia at Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA
| | - William Mihalko
- Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering University of Tennessee, 956 Court Avenue, Memphis, TN 32116, USA
| | - Khaled J Saleh
- Department of Orthopaedics, Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA.
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Sayeed Z, Abaab L, El-Othmani M, Pallekonda V, Mihalko W, Saleh KJ. Total Hip Arthroplasty in the Outpatient Setting: What You Need to Know (Part 1). Orthop Clin North Am 2018; 49:17-25. [PMID: 29145980 DOI: 10.1016/j.ocl.2017.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 02/02/2023]
Abstract
The method by which surgeons conduct outpatient total hip arthroplasty (THA) procedures has yet to be fully standardized. Careful examination of components involved in the preoperative phase of outpatient hip arthroplasty procedures may lead to improved outcomes. This article will discuss methods for implementing successful outpatient THA protocols. Specifically it reviews information regarding patient selection criteria, preoperative education, and preoperative medical optimization.
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Affiliation(s)
- Zain Sayeed
- Department of Orthopaedics, Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA
| | - Leila Abaab
- Department of Orthopaedics, Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA; Department of Anesthesiology - NorthStar Anesthesia at Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA
| | - Mouhanad El-Othmani
- Department of Orthopaedics, Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA
| | - Vinay Pallekonda
- Department of Anesthesiology - NorthStar Anesthesia at Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA
| | - William Mihalko
- Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering University of Tennessee, 956 Court Avenue, Memphis, TN 32116, USA
| | - Khaled J Saleh
- Department of Orthopaedics, Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA.
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29
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Mayfield A, Singaraju V, Anoushiravani AA, Sayeed Z, Saleh JK, Saleh KJ. A Novel Technique Utilizing a Vastus Lateralis Anchor in Treatment of Chronic Patellar Dislocation After Total Knee Arthroplasty. J Surg Orthop Adv 2017; 26:166-172. [PMID: 29130878] [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: 06/07/2023]
Abstract
Extensor mechanism complications involving the patella frequently result in total knee arthroplasty (TKA) failure. Postoperative patellar dislocation may be caused by soft tissue imbalance, improper sizing, and position of the prosthesis. This report describes a case of revision TKA requiring several rounds of soft tissue releases in an effort to treat the patient's chronic patellar dislocation. In the process, a novel surgical approach was developed for the surgical management of refractory chronic patellar dislocations. Postoperative follow-up at 1, 2, 6, 12, and 24 months indicated no complaints of patellar subluxation or dislocation. Plain films also demonstrated no effusion, fracture, or patellar dislocation on sunrise, anteroposterior, and lateral views. This novel anatomic repositioning of the vastus lateralis around the quadriceps tendon converted a pathologic lateralizing force into a medial stabilizer. On follow-up evaluations, successful patellar tracking without dislocation has been demonstrated. (Journal of Surgical Orthopaedic Advances.
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Affiliation(s)
- Allison Mayfield
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Vamsi Singaraju
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Afshin A Anoushiravani
- Division of Orthopaedic Surgery, Department of Surgery, Albany Medical College, Albany, New York
| | - Zain Sayeed
- Department of Surgery, Chicago Medical School, North Chicago, Illinois
| | - Jamal K Saleh
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Khaled J Saleh
- Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, Michigan.
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Zeineddine HA, Frush TJ, Saleh ZM, El-Othmani MM, Saleh KJ. Applications of Tissue Engineering in Joint Arthroplasty: Current Concepts Update. Orthop Clin North Am 2017; 48:275-288. [PMID: 28577777 DOI: 10.1016/j.ocl.2017.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 02/02/2023]
Abstract
Research in tissue engineering has undoubtedly achieved significant milestones in recent years. Although it is being applied in several disciplines, tissue engineering's application is particularly advanced in orthopedic surgery and in degenerative joint diseases. The literature is full of remarkable findings and trials using tissue engineering in articular cartilage disease. With the vast and expanding knowledge, and with the variety of techniques available at hand, the authors aimed to review the current concepts and advances in the use of cell sources in articular cartilage tissue engineering.
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Affiliation(s)
- Hussein A Zeineddine
- Department of Surgery, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL 60637, USA
| | - Todd J Frush
- Department of Orthopaedics and Sports Medicine, Detroit Medical Center, University Health Center (UHC) 9B, 4201 Saint Antoine Street, Detroit, MI 48201-2153, USA
| | - Zeina M Saleh
- Department of Surgery, American University of Beirut Medical Center, Bliss Street, Riad El-Solh, Beirut 11072020, Lebanon
| | - Mouhanad M El-Othmani
- Department of Orthopaedics and Sports Medicine, Musculoskeletal Institute of Excellence, Detroit Medical Center, University Health Center (UHC) 9B, 4201 Saint Antoine Street, Detroit, MI 48201-2153, USA
| | - Khaled J Saleh
- Department of Orthopaedics and Sports Medicine, Detroit Medical Center, University Health Center (UHC) 9B, 4201 Saint Antoine Street, Detroit, MI 48201-2153, USA.
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31
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Abstract
Patients undergoing orthopedic surgery have an increased risk for deep venous thrombosis (DVT) and pulmonary embolism (PE). These complications are considered detrimental, as they cause major postoperative morbidity and mortality and lead to a substantial health care burden. Because of the high incidence and serious nature of these complications, it is essential for orthopedic surgeons to have a comprehensive knowledge of the risk factors, diagnosis, and treatment of acute DVT and PE. Perioperative management of orthopedic patients to prevent postoperative DVT and PE and optimize postoperative outcomes is also discussed in this review.
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Affiliation(s)
- Jasmine Saleh
- Department of Research Institute, National Institute of Health, 9000 Rockville Pike Street, Bethesda, MD 20892, USA
| | - Mouhanad M El-Othmani
- Department of Orthopaedics and Sports Medicine, Detroit Medical Center, University Health Center (UHC), 4201 Saint Antoine Street, 9B, Detroit, MI 48201-2153, USA
| | - Khaled J Saleh
- Department of Orthopaedics and Sports Medicine, Detroit Medical Center, University Health Center (UHC), 4201 Saint Antoine Street, 9B, Detroit, MI 48201-2153, USA.
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32
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Sayeed Z, Anoushiravani AA, El-Othmani MM, Chambers MC, Mihalko WM, Jiranek WA, Paprosky WG, Saleh KJ. Two-Stage Revision Total Knee Arthroplasty in the Setting of Periprosthetic Knee Infection. Instr Course Lect 2017; 66:249-262. [PMID: 28594503] [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: 06/07/2023]
Abstract
Two-stage revision total knee arthroplasty (TKA) is the standard of care for patients who require a revision procedure for the mangement of a late or chronic periprosthetic knee infection. A careful examination of two-stage revision TKA is warranted as the number of patients who require revision TKA in the United States continues to rise. Surgeons should understand the intricacies involved in two-stage revision TKA, including the indications, procedural variations, and current deliberations on two-stage revision TKA in the literature. Surgeons also should understand the alternative treatments for periprosthetic knee infections.
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Affiliation(s)
- Zain Sayeed
- Researcher, Chicago Medical School, North Chicago, Illinois
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33
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Anoushiravani AA, Sayeed Z, El-Othmani MM, Chambers MC, Mihalko WM, Jiranek WA, Paprosky WG, Saleh KJ. Single-Stage Revision Total Knee Arthroplasty in the Setting of Periprosthetic Knee Infection: Indications, Contraindications, and Postoperative Outcomes. Instr Course Lect 2017; 66:235-247. [PMID: 28594502] [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: 06/07/2023]
Abstract
Single-stage revision total knee arthroplasty has become an increasingly common treatment option for patients with failed knee prostheses. Periprosthetic knee infection is the leading and most devastating cause of revision total knee arthroplasty. Although periprosthetic knee infection has been extensively studied in the orthopaedic literature, the role of single-stage revision total knee arthroplasty for the treatment of periprosthetic knee infection warrants further research. As healthcare reform shifts from a volume-based to a value-based system, it is imperative that orthopaedic surgeons understand the procedural indications, risks, and benefits of single-stage revision total knee arthroplasty.
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Affiliation(s)
- Afshin A Anoushiravani
- Clinical Research Fellow, Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York
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34
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Mahmood B, El-Othmani MM, Mihalko WM, Jiranek WA, Paprosky WG, Saleh KJ. Prevention and Diagnosis of Periprosthetic Knee Infection. Instr Course Lect 2017; 66:223-233. [PMID: 28594501] [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: 06/07/2023]
Abstract
Total knee arthroplasty (TKA) has become an increasingly common treatment option for patients who have debilitating knee arthritis. TKA is a relatively safe and efficient procedure that results in promising outcomes and has a positive effect on a patient's quality of life. More TKAs are being performed annually because the procedure substantially reduces pain and improves functionality; however, as the number of TKAs continues to rise, there is concern for potential complications that may result in prosthetic joint failure. Primary TKA failure may result in revision procedures that have high costs and an increased risk for additional complications. Infection is the second most common cause of primary TKA failure and the single most common cause of revision TKA failure. Surgeons who have a better understanding of the epidemiology, risk factors, and diagnostic modalities associated with periprosthetic knee infection will be able to implement preventive measures and treat patients in whom such a complication occurs.
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Affiliation(s)
- Bilal Mahmood
- Orthopaedic Surgery Resident, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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35
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Saleh KJ, Sayeed Z, Anoushiravani AA, Darwiche HF, Little B, Frush TJ, El-Othmani MM. Reimbursement Based on Value in Knee Surgery: What You Need to Know about the Medicare Access and Children's Health Insurance Program Reauthorization Act of 2015. J Knee Surg 2017; 30:12-18. [PMID: 27806385 DOI: 10.1055/s-0036-1593614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 02/07/2023]
Abstract
Health care cost is consuming a large portion of the nation's gross domestic product while placing added economic burdens on physicians and their patients. With total joint replacement being one of the early-targeted procedures in the evolving health care environment, knee surgeons will benefit from developing a critical knowledge on health care reforms and their financial implications. The Medicare Access and Children's Health Insurance Program Reauthorization Act represents a cohesive movement toward value-based payment reform and contains several unchartered rulings that require detailed attention by knee surgeons. In this article, we provide a contextual framework of health care legislation that has led to the formation of the current health policy, and present a comprehensive summary and update on the Merit-Based Incentive Payment Systems and Alternative Payment Models reimbursement models.
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Affiliation(s)
- Khaled J Saleh
- Department of Orthopaedics and Sports Medicine, Detroit Medical Center, Detroit, Michigan
| | - Zain Sayeed
- Department of Orthopaedics, Chicago Medical School, Chicago, Illinois
| | | | - Hussein F Darwiche
- Department of Orthopaedics and Sports Medicine, Detroit Medical Center, Detroit, Michigan
| | - Bryan Little
- Department of Orthopaedics and Sports Medicine, Detroit Medical Center, Detroit, Michigan
| | - Todd James Frush
- Department of Orthopaedics and Sports Medicine, Detroit Medical Center, Detroit, Michigan
| | - Mouhanad M El-Othmani
- Department of Orthopaedics and Sports Medicine, Detroit Medical Center, Detroit, Michigan
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Voss B, El-Othmani MM, Schnur AK, Botchway A, Mihalko WM, Saleh KJ. A Meta-Analysis Comparing All-Polyethylene Tibial Component to Metal-Backed Tibial Component in Total Knee Arthroplasty: Assessing Survivorship and Functional Outcomes. J Arthroplasty 2016; 31:2628-2636. [PMID: 27538714 DOI: 10.1016/j.arth.2015.08.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 04/20/2015] [Revised: 07/20/2015] [Accepted: 08/27/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This meta-analysis compares the clinical performance of all-polyethylene tibial (APT) to the metal-backed tibial (MBT) components. METHODS We included comparative studies in primary total knee arthroplasty involving APT and MBT implant components. The primary outcomes were function, durability, and reports of adverse events. RESULTS Twenty-eight articles with 95 847 knees were available for synthesis. The meta-analysis showed an association of APT with lower revision rates (incidence rate ratio, 0.709; P = .002) and adverse events (incidence rate ratio, 0.785; P = .204). Moderator analyses were performed to determine the effect of posterior cruciate ligament status on outcome, and no statistically significant effect was found for revision risk or adverse events incidence. CONCLUSION All-polyethylene tibial components seem to be an equal option, with less financial burden than the MBT.
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Affiliation(s)
- Benjamin Voss
- Southern Illinois University School of Medicine, Springfield, Illinois
| | - Mouhanad M El-Othmani
- Department of Orthopaedics and Sports Medicine, Detroit Medical Center, Detroit, Michigan
| | | | - Albert Botchway
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, Illinois
| | - William M Mihalko
- Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee, Memphis, Tennessee
| | - Khaled J Saleh
- Department of Orthopaedics and Sports Medicine, Detroit Medical Center, Detroit, Michigan
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37
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Abstract
Surgical site infection in total joint arthroplasty is a challenging complication that warrants discussion with regard to prevention and management. Limiting postoperative infection rate is a paramount quest in the orthopedic community. Several preoperative risk factors have been identified in orthopedic literature with regards to likelihood of developing postoperative infection. This article evaluates several factors that predispose total joint arthroplasty patients to infection. Methods of patient surgical preparation designed to decrease postoperative infection, decreasing intraoperative traffic during procedural settings, and elaborate intraoperative prophylactic advancements are assessed. Approaches to decrease postoperative infection by discussing means of lowering rates of postoperative transfusion, wound drainage, and hematoma formation are analyzed.
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Affiliation(s)
- Daniel Hatz
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Afshin A Anoushiravani
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Monique C Chambers
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Mouhanad M El-Othmani
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Khaled J Saleh
- Department of Orthopaedic and Sports Medicine, Detroit Medical Center, 311 Mack Avenue, 5th Floor, Detroit, MI 48201, USA.
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Abstract
Patient-centered care (PCC) is gaining considerable momentum among health care professionals and policy-making authorities. The need for PCC stems from the innumerable benefits of adopting such a system. The practice of PCC in orthopedic surgery in general, and in total joint replacement in particular, is still in its youth. However, present literature already establishes the need for applying PCC in total joint replacement. Extensive research and effort should be invested to better grasp and define the dimensions of PCC as they relate to total joint replacement.
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Affiliation(s)
- Hussein A Zeineddine
- Department of Surgery, University of Chicago, 5812 South Ellis Avenue, Chicago, IL 60637, USA
| | - Mouhanad M El-Othmani
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Zain Sayeed
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Monique C Chambers
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Khaled J Saleh
- Department of Orthopaedic and Sports Medicine, Detroit Medical Center, 311 Mack Avenue, 5th Floor, Detroit, MI 48201, USA.
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Abstract
The US health care system has been fragmented for more than 40 years; this model created a need for modification. Sociopoliticomedical system-related factors led to the Affordable Care Act (ACA) and a restructuring of health care provision/delivery. The ACA increases access to high-quality "affordable care" under cost-effective measures. This article provides a comprehensive review of health reform and the motivating factors that drive policy to empower arthroplasty providers to effectively advocate for the field of orthopedics as a whole, and the patients served.
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Affiliation(s)
- Monique C Chambers
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Mouhanad M El-Othmani
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Khaled J Saleh
- Department of Orthopaedic and Sports Medicine, Detroit Medical Center, 311 Mack Avenue, 5th Floor, Detroit, MI 48201, USA.
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Sayeed Z, El-Othmani MM, Anoushiravani AA, Chambers MC, Saleh KJ. Planning, Building, and Maintaining a Successful Musculoskeletal Service Line. Orthop Clin North Am 2016; 47:681-8. [PMID: 27637654 DOI: 10.1016/j.ocl.2016.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 02/02/2023]
Abstract
Within the past 3 decades, a recent trend in the growth of musculoskeletal service lines has been seen nationally. Orthopedics offers an appealing concourse for implementation of service-line care. Within this review, the authors address the components involved in planning and building a musculoskeletal service line. The authors also address methods by which orthopedic surgeons can maintain the efficacy of their service lines by examining how orthopedic surgeons can navigate their service line through recent advents in health care reform. Finally, the authors review successful examples of musculoskeletal service lines currently in practice within the orthopedic community.
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Affiliation(s)
- Zain Sayeed
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Mouhanad M El-Othmani
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Afshin A Anoushiravani
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Monique C Chambers
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Khaled J Saleh
- Department of Orthopaedic and Sports Medicine, Detroit Medical Center, 311 Mack Avenue, 5th Floor, Detroit, MI 48201, USA.
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Shaha SH, Sayeed Z, Anoushiravani AA, El-Othmani MM, Saleh KJ. Big Data, Big Problems: Incorporating Mission, Values, and Culture in Provider Affiliations. Orthop Clin North Am 2016; 47:725-32. [PMID: 27637659 DOI: 10.1016/j.ocl.2016.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This article explores how integration of data from clinical registries and electronic health records produces a quality impact within orthopedic practices. Data are differentiated from information, and several types of data that are collected and used in orthopedic outcome measurement are defined. Furthermore, the concept of comparative effectiveness and its impact on orthopedic clinical research are assessed. This article places emphasis on how the concept of big data produces health care challenges balanced with benefits that may be faced by patients and orthopedic surgeons. Finally, essential characteristics of an electronic health record that interlinks musculoskeletal care and big data initiatives are reviewed.
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Affiliation(s)
- Steven H Shaha
- Center for Public Policy and Administration, 260 South Central Campus Drive, Room 214, University of Utah, Salt Lake City, UT 84112, USA
| | - Zain Sayeed
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Afshin A Anoushiravani
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Mouhanad M El-Othmani
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Khaled J Saleh
- Department of Orthopaedic and Sports Medicine, Detroit Medical Center, 311 Mack Avenue, 5th Floor, Detroit, MI 48201, USA.
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Sayeed Z, Anoushiravani AA, Chambers MC, Gilbert TJ, Scaife SL, El-Othmani MM, Saleh KJ. Comparing In-Hospital Total Joint Arthroplasty Outcomes and Resource Consumption Among Underweight and Morbidly Obese Patients. J Arthroplasty 2016; 31:2085-90. [PMID: 27080111 DOI: 10.1016/j.arth.2016.03.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 12/19/2015] [Revised: 02/24/2016] [Accepted: 03/08/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND As orthopedic surgeons search for objective measures that predict total joint arthroplasty (TJA) outcomes, body mass index may aid in risk stratification. The purpose of this study was to compare in-hospital TJA outcomes and resource consumption amongst underweight (body mass index ≤19 kg/m(2)) and morbidly obese patients (≥40 kg/m(2)). METHODS Discharge data from 2006 to 2012 National Inpatient Sample were used for this study. A total of 1503 total hip arthroplasty (THA) and 956 total knee arthroplasty (TKA) patients were divided into 2 cohorts, underweight (≤19 kg/m(2)) and morbidly obese (≥40 kg/m(2)). Patients were matched by gender and 27 comorbidities by use of Elixhauser Comorbidity Index. Patients were compared for 13 in-hospital postoperative complications, length of stay, total hospital charge, and disposition. Multivariate analyses were generated by SAS software. Significance was assigned at P value <.05. RESULTS Underweight patients undergoing primary TJA had higher risk for developing postoperative anemia compared with morbidly obese patients (TKA: odds ratio [OR], 3.1; 95% CI, 2.3-4.1; THA: OR, 1.8; 95% CI, 1.5-2.3). Underweight THA candidates displayed greater risk for deep venous thrombosis (75.36% vs 24.64%; OR, 3.1; 95% CI, 1.1-8.4). Underweight TJA patients were charged more (TKA: USD 51,368.90 vs USD 40,128.80, P = .001, THA: USD 57,451.8 vs USD 42,776.9, P < .001) compared to the morbidly obese patients. Length of stay was significantly longer for underweight THA patients (4.6 days vs 3.5 days, P = .008) compared to morbidly obese counterparts. CONCLUSION Our results indicate underweight, compared to morbidly obese, TJA patients are at a greater risk for postoperative anemia and consume more resources.
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Affiliation(s)
- Zain Sayeed
- Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois
| | - Afshin A Anoushiravani
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Monique C Chambers
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Theodore J Gilbert
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Steven L Scaife
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Mouhanad M El-Othmani
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
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43
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Abstract
As health care reimbursement models shift from volume-based to value-based models, orthopedic surgeons must provide patients with highly reliable care, while consciously minimizing cost, maintaining quality, and providing timely interventions. An established means of achieving these goals is by implementing a highly reliable care model; however, before such a model can be initiated, a safety culture, robust improvement strategies, and committed leadership are needed. This article discusses interdependent and critical changes required to implement a highly reliable care system. Specific operative protocols now mandated are discussed as they pertain to high reliability of orthopedic care and elimination of wrong-site procedures.
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Affiliation(s)
- Afshin A Anoushiravani
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Zain Sayeed
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Mouhanad M El-Othmani
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Peter K Wong
- Illinois Divisions, HSHS Medical Group, Hospitals Sisters Health System (HSHS), 800 E Carpenter St, Springfield, IL 62707, USA
| | - Khaled J Saleh
- Department of Orthopaedic and Sports Medicine, Detroit Medical Center, 311 Mack Avenue, 5th Floor, Detroit, MI 48201, USA.
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Abstract
As health care reforms continue to improve quality of care, significant emphasis will be placed on evaluation of orthopedic patient outcomes. Total joint arthroplasty (TJA) has a proven track record of enhancing patient quality of life and are easily replicable. The outcomes of these procedures serve as a measure of health care initiative success. Specifically, length of stay, will be targeted as a marker of quality of surgical care delivered to TJA patients. Within this review, we will discuss preoperative and postoperative methods by which orthopedic surgeons may enhance TJA outcomes and effectively reduce length of stay.
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Affiliation(s)
- Megan Walters
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Monique C Chambers
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Zain Sayeed
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Afshin A Anoushiravani
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Mouhanad M El-Othmani
- Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA
| | - Khaled J Saleh
- Department of Orthopaedic and Sports Medicine, Detroit Medical Center, 311 Mack Avenue, 5th Floor, Detroit, MI 48201, USA.
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Anoushiravani AA, Sayeed Z, Chambers MC, Gilbert TJ, Scaife SL, El-Othmani MM, Saleh KJ. Assessing In-Hospital Outcomes and Resource Utilization After Primary Total Joint Arthroplasty Among Underweight Patients. J Arthroplasty 2016; 31:1407-12. [PMID: 27133161 DOI: 10.1016/j.arth.2015.12.053] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 09/12/2015] [Revised: 12/11/2015] [Accepted: 12/17/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Poor nutritional status is a preventable condition frequently associated with low body mass index (BMI). The purpose of this study is to comparatively analyze low (≤19 kg/m(2)) and normal (19-24.9 kg/m(2)) BMI cohorts, examining if a correlation between BMI, postoperative outcomes, and resource utilization exists. METHODS Discharge data from the 2006-2012 National Inpatient Sample were used for this study. A total of 3550 total hip arthroplasty (THA) and 1315 total knee arthroplasty (TKA) patient samples were divided into 2 cohorts, underweight (≤19 kg/m(2)) and normal BMI (19-24.9 kg/m(2)). Using the Elixhauser Comorbidity Index, all cohorts were matched for 27 comorbidities. In-hospital postoperative outcomes and resource utilization among the cohorts was then comparatively analyzed. Multivariate analyses and chi-squared tests were generated using SAS software. Significance was assigned at P < .05. RESULTS Underweight patients undergoing THA were at higher risk of developing postoperative anemia and sustaining cardiac complications. In addition, underweight patients had a decreased risk of developing postoperative infection. Resource utilization in terms of length of stay and hospital charge were all higher in the underweight THA cohort. Similarly, in the underweight TKA cohort, a greater risk for the development of hematoma/seroma and postoperative anemia was observed. Underweight TKA patients incurred higher hospital charge and were more likely to be discharged to skilled nursing facilities. CONCLUSION Our results indicate that low-BMI patients were more likely to have postoperative complications and greater resource utilization. This serves a purpose in allowing orthopedic surgeons to better predict patient outcomes and improve treatment pathways designed toward helping various patient demographics.
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Affiliation(s)
| | - Zain Sayeed
- Chicago Medical School, North Chicago, Illinois
| | - Monique C Chambers
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Theodore J Gilbert
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Steven L Scaife
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Mouhanad M El-Othmani
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, Illinois
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Hakki S, El-Othmani MM, Gabriel C, Mihalko WM, Saleh KJ. Assessing Tibial Tray Rotation in TKA: A Cadaveric Study. Orthopedics 2016; 39:S67-71. [PMID: 27219733 DOI: 10.3928/01477447-20160509-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/16/2016] [Accepted: 04/21/2016] [Indexed: 02/03/2023]
Abstract
Tibial anatomical landmarks for transverse plane rotation of the tibial tray have not been validated. The current authors propose aligning the tibial tray with both the anterior tibial center point of rotation (ATCPR) and the femoral trochlear groove (FTG) to establish the ideal tibial tray rotation in total knee arthroplasty (TKA). When the tibial tray centerline was aligned with ATCPR and FTG lines, the mean range of motion (ROM) was 144.3° (preoperatively 145°) and tibial rotation range was 22.8 mm (preoperatively, 24.9 mm). When the tibial component was rotated 5 mm medially to the ATCPR, the knee ROM decreased in flexion with patellar subluxation, while it decreased in extension when rotated 5 mm laterally. This method identifies the ideal tibial tray rotation in TKA, at which maximal range of tibial rotation and knee ROM are achieved without obvious overriding of components. [Orthopedics, 2016; 39(3):S67-S71.].
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Beason AM, Zhang H, Anoushiravani AA, Sayeed Z, Chambers MC, El-Othmani MM, Mihalko WM, Saleh KJ. Postoperative Radiographic Assessment of the Vega Posterior-Stabilized TKA. Orthopedics 2016; 39:S56-60. [PMID: 27219730 DOI: 10.3928/01477447-20160509-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/16/2016] [Accepted: 04/11/2016] [Indexed: 02/03/2023]
Abstract
Different biomechanical designs are incorporated into various total knee arthroplasty (TKA) implants. The posterior-stabilized prosthesis design utilizes a polyethylene post and femoral cam in place of the posterior cruciate ligament. This produces a more stable component interface, increased range of motion, and potentially a less technical procedure. This study aimed to assess the short-term (>2 year) outcomes associated with the Vega System posterior-stabilized knee prosthesis (Aesculap Implant Systems, Center Valley, Pennsylvania) based on postoperative radiographs using the Knee Society Roentgenographic Evaluation and Scoring System (KSRESS). Thirty-seven TKA patients who had received the Vega posterior-stabilized knee prosthesis and had postoperative radiographs at each follow-up for a minimum of 2 years were enrolled, retrospectively. Two independent observers evaluated the radiographs using KSRESS. Descriptive statistics were used to analyze the data. The average age and body mass index of patients enrolled was 67 years (range, 51-89 years) and 38.5 kg/m(2) (range, 21.2-54 kg/m(2)), respectively. Patients had radiographic follow-up for an average of 36 months (range, 24-58 months). Comparison between first and last available postoperative radiographs revealed a stable femoral and tibial interface with no significant change in prosthesis alignment over the follow-up period. Assessment of the short-term survivorship of the Vega posterior-stabilized prosthesis using KSRESS revealed no significant change in alignment after 2 years of follow-up; however, mid- to long-term studies assessing this junction are needed. A future prospective study using KSRESS in combination with clinical follow-up is recommended to allow comparison of the Vega posterior-stabilized to other prostheses. [Orthopedics. 2016; 39(3):S56-S60.].
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Saleh KJ, El Othmani MM, Tzeng TH, Mihalko WM, Chambers MC, Grupp TM. Acrylic bone cement in total joint arthroplasty: A review. J Orthop Res 2016; 34:737-44. [PMID: 26852143 DOI: 10.1002/jor.23184] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [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: 12/10/2015] [Accepted: 02/03/2016] [Indexed: 02/04/2023]
Abstract
Acrylic bone cement has a variety of applications in orthopedic surgery. Primary uses in total arthroplasties are limited to prostheses fixation and antibiotic delivery. With the large number of total joint arthroplasties expected to continue to rise, understanding the role bone cement plays in the success of total joint arthroplasty can have a significant impact on daily practice. The literature is inconclusive on whether cemented or cementless fixation technique is superior, and choice of fixation type is mainly determined by surgeon preference and experience. Surgeons should understand that if poor techniques exist, short-term outcomes of the replaced joint may be at risk. Statement of clinical significance: This article attempts to clarify some points of bone cement use through a review of the mechanical properties related to bone cement, a comparison to alternative materials, influence of additives, and the effects on surgical outcomes. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:737-744, 2016.
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Affiliation(s)
- Khaled J Saleh
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, 62794-9679
| | - Mouhanad M El Othmani
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, 62794-9679
| | - Tony H Tzeng
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, 62794-9679
| | - William M Mihalko
- Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee, 956 Court Ave, Suite E226, Memphis, Tennessee, 38163
| | - Monique C Chambers
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, 62794-9679
| | - Thomas M Grupp
- Clinic for Orthopaedic Surgery, Campus Grosshadern, Ludwig Maximilians University, Munich, Germany Aesculap AG, Research & Development, Tuttlingen, Germany
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Chambers MC, El-Othmani MM, Sayeed Z, Anoushiravani A, Schnur AK, Mihalko WM, Saleh KJ. Economics of All-Polyethylene Versus Metal-Backed Tibial Prosthesis Designs. Orthopedics 2016; 39:S61-6. [PMID: 27219732 DOI: 10.3928/01477447-20160509-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 02/16/2016] [Accepted: 04/11/2016] [Indexed: 02/03/2023]
Abstract
With the large number of total knee arthroplasties being performed and expectations that these numbers will be on the rise over the coming decades, efforts to provide cost-efficient care are of greater interest. The preferred design of knee arthroplasty implants has changed over time, with the original all-polyethylene tibial (APT) design being replaced by metal-backed tibial (MBT) components, as well as more recent considerations of newer APT designs. Modern APT components have been shown to have similar or superior outcomes than MBT components. Despite their limitations, APT components can be used to reduce the economic burden to the provider, medical institution, and health care system as a whole. There is a paucity of evidence-based literature directly comparing the cost associated with APT and MBT components. The purpose of this report is to review the literature to assess the available data regarding direct and indirect costs of both designs so that orthopedic surgeons can account for economic differences in everyday practice. [Orthopedics. 2016; 39(3):S61-S66.].
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Saleh J, Wright E, El-Othmani MM, Lane JM, Mihalko WM, Saleh KJ. Cardiovascular Considerations for Joint Replacement Surgery. Instr Course Lect 2016; 65:477-486. [PMID: 27049213] [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: 06/05/2023]
Abstract
Heart disease is the leading cause of death in the United States. Cardiovascular complications are associated with higher morbidity and mortality rates for patients who undergo orthopaedic surgery. Therefore, the clinical importance of a comprehensive preoperative evaluation and medical clearance is crucial and may substantially improve postoperative outcomes. A thorough knowledge of cardiovascular perioperative planning and management can enable healthcare professionals to identify patients who are potentially at risk for cardiovascular complications, and eventually improve both short- and long-term patient outcomes and satisfaction.
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Affiliation(s)
- Jasmine Saleh
- Intramural Research Training Award Fellow, National Institutes of Health, Bethesda, Maryland
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