Utility of the modified 5-item frail index to predict complications and reoperations after hallux valgus percutaneous surgery

INTRODUCTION

The modified 5-item frailty index (mFI-5) has been recently proposed as a useful tool for predicting postoperative complications in orthopedic surgery. We aimed to analyze the utility of this score in predicting complications and reoperations after hallux valgus (HV) deformity surgery.

METHODS

551 patients undergoing percutaneous HV corrective surgery were retrospectively reviewed. The mFI-5 was calculated based and patients were categorized in three groups: 1) non-frail: patients without any of the 5 comorbidities, 2) pre-frail: patients with one comorbidity and 3) frail: patients with two or more comorbidities. Complications and surgical reoperations were recorded.

RESULTS

In the study period 772 percutaneous surgeries were performed to correct HV deformity, 551 patients were included with a median age of 60 (IQR 48-70). Three hundred eighty-nine patients were non-frail (70.6%), 132 were pre-frail (23.9%) and 30 were frail (5.4%). 75 patients suffered complications (13.6%). Even though the rate of complications was higher in frailty patients (23.3%) compared with pre-frail (13.6%) and non frail (12.8%), no significant differences were observed among groups. 48 patients required reoperation (8.7%) but the rate of reoperations among frailty groups was not significantly different (P=.11). Frailty patients had worse AOFAS scores at final follow up (P=.011).

CONCLUSION

The mFI-5 was not useful to predict postoperative complications and reoperations after hallux valgus corrective surgery. Therefore, other factors should be considered when analyzing the risk of complications after HV corrective surgery.

Utility of the modified 5-item frail index to predict complications and reoperations after hallux valgus surgery

INTRODUCTION

The modified 5-item frailty index (mFI-5) has been recently proposed as a useful tool for predicting postoperative complications in orthopedic surgery. We aimed to analyze the utility of this score in predicting complications and reoperations after hallux valgus (HV) deformity surgery.

METHODS

551 patients undergoing percutaneous HV corrective surgery were retrospectively reviewed. The mFI-5 was calculated based and patients were categorized in three groups: (1) non-frail: patients without any of the 5 comorbidities, (2) pre-frail: patients with one comorbidity and (3) frail: patients with two or more comorbidities. Complications and surgical reoperations were recorded.

RESULTS

In the study period 772 percutaneous surgeries were performed to correct hallux valgus deformity, 551 patients were included with a median age of 60 (IQR 48-70). 389 patients were non-frail (70.6%), 132 were pre-frail (23.9%) and 30 were frail (5.4%). 75 patients suffered complications (13.6%). Even though the rate of complications was higher in frailty patients (23.3%) compared with pre-frail (13.6%) and non frail (12.8%), no significant differences were observed among groups. 48 patients required reoperation (8.7%) but the rate of reoperations among frailty groups was not significantly different (p=0.11). Frailty patients had worse AOFAS scores at final follow up (p=0.011).

CONCLUSION

The mFI-5 was not useful to predict postoperative complications and reoperations after hallux valgus corrective surgery. Therefore, other factors should be considered when analyzing the risk of complications after HV corrective surgery.

Advancing plastic pollution hotspotting at the subnational level: Brazil as a case study in the Global South

Identifying sources is crucial for proposing effective actions to combat marine litter pollution. Here, we used an innovative approach to identify hotspots of mismanaged plastic waste (MPW) within Brazil and subsequent leakage to the ocean, based on population density, socio-economic conditions, municipal solid waste management and environmental parameters. We estimated plastic waste generation and MPW for each of the 5570 Brazilian municipalities, which totaled 3.44 million metric tons per year. Then, we estimated the probability of litter mobilization and transport (P) and the relative risk of leakage to the ocean (MPW × P). The Guanabara Bay and La Plata River comprised the main oceanic entry hotspots of litter produced in Brazil. The use of national databases allowed us to increase spatial and temporal granularity, offering a detailed baseline for the application of prevention and mitigation actions. However, overcoming data limitations is still a challenge in Brazil as in other Global South countries.

How far are we from robust estimates of plastic litter leakage to the environment?

Litter pollution is a global concern, and identifying sources and pathways is crucial for proposing preventative actions. Existing models of plastic litter leakage to the environment have provided worldwide estimates at a country-based level, but only a few initiatives address subnational scales. Adding relevant parameters and improving models is needed to reduce the limitations of global estimates. However, availability of information, which varies among countries and is critical in the Global South, may preclude such improvements. To understand the potentialities and limitations of subnational estimates of plastic litter leakage to the environment, we reviewed the parameters used in the literature and addressed data usability, considering Brazil as a case study. We gathered data on parameters identified for all 5570 Brazilian municipalities and evaluated their usability considering reliability and temporal and geographic granularity. We identified 51 parameters that are either currently used in models or could improve estimates, including parameters regarding territory, population density, socioeconomic condition, and solid waste generation, composition, collection, and final destination, selective waste collection, recycling, and hydrology. Only 29.4% of parameters were linked to data sources with good or very good usability, while most of them presented average usability (45.1%) and 7.8% were not linked to any data source. This panorama of low data usability reveals uncertainties and explicit difficulties of estimating plastic litter leakage to the environment, including mobilization from the terrestrial environment to the ocean. The Brazilian scenario reflects current data availability conditions and the difficulties of countries in the Global South to robustly understand plastic litter leakage and face land-based sources of marine litter.

Areas of endemism of land planarians (Platyhelminthes: Tricladida) in the Southern Atlantic Forest

Areas of endemism (AoE) are the main study units in analytical biogeographic methods, and are often defined as an area with two or more endemic species living in them, presenting substantial congruence among their range limits. We explored the distribution of land planarians (Geoplanidae, Platyhelminthes) across the southern region of the Brazilian Atlantic forest (from the state of Rio de Janeiro, to the state of Rio Grande do Sul) utilizing DaSilva's et al. (2015) protocol. We used two methods, Endemicity Analysis (EA), and Geographical Interpolation of Endemism (GIE). We identified nine AoE of terrestrial flatworms in the Southern Atlantic forest. Performance of the methodologies is discussed. These AoE of land planarians can be explained through vicariance events combined with their physiological and ecological own limitations. Interestingly, these AoE are congruent with fine-scale approaches such as that with harvestmen. Most land planarians have revealed to present a very small distributional range evidencing their potential as a good model for fine-scale studies of AoE.

Reported health conditions in animals residing near natural gas wells in southwestern Pennsylvania

Natural gas extraction activities, including the use of horizontal drilling and hydraulic fracturing, may pose potential health risks to both human and animal populations in close proximity to sites of extraction activity. Because animals may have increased exposure to contaminated water and air as well as increased susceptibility to contaminant exposures compared to nearby humans, animal disease events in communities living near natural gas extraction may provide "sentinel" information useful for human health risk assessment. Community health evaluations as well as health impact assessments (HIAs) of natural gas exploration should therefore consider the inclusion of animal health metrics in their assessment process. We report on a community environmental health survey conducted in an area of active natural gas drilling, which included the collection of health data on 2452 companion and backyard animals residing in 157 randomly-selected households of Washington County, Pennsylvania (USA). There were a total of 127 reported health conditions, most commonly among dogs. When reports from all animals were considered, there were no significant associations between reported health condition and household proximity to natural gas wells. When dogs were analyzed separately, we found an elevated risk of 'any' reported health condition in households less than 1km from the nearest gas well (OR = 3.2, 95% CI 1.07-9.7), with dermal conditions being the most common of canine disorders. While these results should be considered hypothesis generating and preliminary, they suggest value in ongoing assessments of pet dogs as well as other animals to better elucidate the health impacts of natural gas extraction on nearby communities.

Increasing frequency of heterosexually transmitted AIDS in southern Florida: artifact or reality?

Acquired immunodeficiency syndrome (AIDS) cases reported as the result of heterosexual contact have been increasing in the United States, with Florida reporting a disproportionate number. We investigated 168 such AIDS cases from southern Florida. After follow-up, 50 (30%) patients were reclassified into other transmission categories. The data suggest that the increased rate of heterosexually acquired AIDS cases reported from southern Florida was partially related to misclassification of risk.