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Chiu AK, Agarwal AR, Hussain N, Gu A, Thakkar S, Golladay GJ. Trends in Venous Thromboembolism and Chemoprophylaxis Utilization in Elective Total Knee Arthroplasty from 2011 to 2020. J Arthroplasty 2024:S0883-5403(24)00458-3. [PMID: 38759821 DOI: 10.1016/j.arth.2024.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION Venous thromboembolism (VTE) is a feared complication of joint arthroplasty, leading to recent clinical practice guidelines (CPGs) aimed at VTE prevention and prophylaxis. However, limited studies have examined national changes in practice regarding chemoprophylaxis and the resultant changes in VTE rates. The purpose of this study was to identify: 1) the temporal trends in thrombotic complications; and 2) changes in chemoprophylaxis utilization in patients undergoing elective TKA. METHODS A retrospective study was conducted using a large all-payer claims dataset. Patients who underwent osteoarthritis-indicated TKA between 2011 and 2020 were identified. Annual rates of VTE, including deep vein thrombosis (DVT), and pulmonary embolism (PE), within 90 days of TKA were determined. Utilization patterns for postoperative aspirin and anticoagulant medications were observed. Temporal trends were analyzed with linear regression and the calculation of the cumulative annual growth rate (CAGR). Multivariable logistic regression was conducted to account for the effects of age and comorbidities. RESULTS A total of 1,263,351 TKA patients were identified between 2011 and 2020. There were significant reductions in VTE rates (2.9% in 2011 to 1.8% in 2020), DVT rates (2.0% in 2011 to 1.3% in 2020), and PE rates (1.1% in 2011 to 0.6% in 2020). Postoperative utilization of aspirin increased from 5.9% in 2011 to 53.2% in 2020, whereas utilization of anticoagulants decreased from 94.1% in 2011 to 46.8% in 2020. Among anticoagulants, direct factor Xa inhibitors had the greatest increase in utilization (4.6 to 69.7%). The average reimbursement-associated with VTE after TKA decreased from $18,061 in 2011 to $7,835 in 2020. DISCUSSION The incidence rate and economic burden of VTE after TKA have significantly declined since 2011. There has been a trend toward increased aspirin and direct oral anticoagulant utilization for postoperative chemoprophylaxis.
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Affiliation(s)
- Anthony K Chiu
- Department of Orthopaedic Surgery, The George Washington University Hospital; Washington, DC, USA.
| | - Amil R Agarwal
- Department of Orthopaedic Surgery, The George Washington University Hospital; Washington, DC, USA
| | - Nauman Hussain
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital; Baltimore, MD, USA
| | - Alex Gu
- Department of Orthopaedic Surgery, The George Washington University Hospital; Washington, DC, USA
| | - Savyasachi Thakkar
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital; Baltimore, MD, USA
| | - Gregory J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Harris AB, Valenzuela J, Andrade N, Agarwal A, Gu A, Golladay G, Thakkar S. Comparison of Pneumonia and Major Complications After Total Joint Arthroplasty With Spinal Versus General Anesthesia: A Propensity-matched Cohort Analysis. J Am Acad Orthop Surg 2024; 32:33-40. [PMID: 37603703 DOI: 10.5435/jaaos-d-23-00192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/05/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION Spinal anesthesia (SA) allows total joint arthroplasty to be done while minimizing opioids and systemic anesthetic agents compared with general anesthesia (GA). SA has been associated with shortened postoperative recovery; however, the relationship between SA, major postoperative complications, and pneumonia (PNA) remains unclear. METHODS Patients in a large, national database who underwent total hip arthroplasty or total knee arthroplasty from 2010 to 2020 were identified. 1:1 propensity score matching was used to create matched groups of patients who underwent SA and GA. The groups were matched by age, sex, chronic obstructive pulmonary disease, smoking status, Charlson Comorbidity Index, and American Society of Anesthesiology (ASA) classification. 1:1 matching was also done among the ASA classifications as a subanalysis. RESULTS Overall, equally matched groups of 217,267 patients who underwent SA versus GA were identified. 850 patients (0.39%) developed postoperative PNA after GA versus 544 patients (0.25%) after SA ( P < 0.001). The risk of major complications was 6,922 (3.2%) in the GA group and 5,401 (2.5%) in the SA group ( P < 0.001). Similarly, the risk of unplanned postoperative reintubation was higher (0.18% versus 0.10%, P < 0.001) and mortality was higher (0.14% versus 0.09%, P < 0.001) in the GA group than in the SA group. In ASA 1 to 3 patients, the risk of PNA was 0.08% to 0.21% higher with GA than with SA. In ASA 4 patients, the risk of PNA was 0.42% higher in SA than in GA (1.92% versus 1.5%, P < 0.001) and the mortality rate was nearly doubled in GA than in SA (1.46% versus 0.77%, P = 0.017). DISCUSSION Overall, GA was associated with a small but markedly higher rate of major complications, mortality, and PNA than SA in patients undergoing total joint arthroplasty when matching for differences in comorbidities. ASA 4 patients experienced the greatest increase in absolute risk of mortality with GA versus SA.
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Affiliation(s)
- Andrew B Harris
- From the Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD (Harris, and Thakkar), the California Health Sciences University, Clovis, CA (Valenzuela), the Department of Anesthesiology, Johns Hopkins Hospital, Baltimore, MD (Andrade), the Department of Orthopaedic Surgery, The George Washington University, Washington, DC (Agarwal, and Gu), the Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA (Golladay), and the Orthopaedics Research Collaborative (ORC) (Harris, Gu, Golladay, and Thakkar)
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Harris AB, Narain S, Gu A, Best M, Thakkar S, Khanuja H, Sterling R. Data-driven preoperative hemoglobin thresholds in patients undergoing Bilateral simultaneous total Knee arthroplasty are similar to patients undergoing unilateral total Knee arthroplasty. Knee 2023; 42:258-263. [PMID: 37105013 DOI: 10.1016/j.knee.2023.03.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/21/2023] [Accepted: 03/02/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Preoperative anemia is a risk factor for transfusions and complications following total knee arthroplasty (TKA). Bilateral TKA (bTKA) is more extensive compared to unilateral TKA (uTKA) and a higher preoperative hemoglobin threshold may be warranted. We hypothesized that the optimal hemoglobin cutoff value which predicts the need for postoperative transfusion would be higher for bTKA than uTKA. METHODS We conducted a case control study using a national database and identified patients undergoing primary TKA from 2010-2020. 1:1, nearest-neighbor propensity-score matching was used to create a cohort of patients undergoing uTKA matched with patients undergoing bTKA based on age, gender, Charlston Comorbidity Index (CCI), and American Society of Anesthesiology (ASA) classification. After 2015, NSQIP discontinued collection of the variables MI, angina, and hemiplegia. Thus, the accuracy of CCI, which was used as a matching variable, will be less accurate after 2015. To explore this limitation further, a sensitivity analysis was performed excluding data after 2015 and there was no change in the significance of our primary outcomes. Hemoglobin thresholds which maximally predict postoperative transfusion risk and 30-day complications were identified using Youden's index. Significance was considered if 95% CI's were non-overlapping. RESULTS 9,891 patients were included in each of the bTKA and uTKA cohorts with successful 1:1 matching (p > 0.05 for all criteria). 3.216 (16 %) of patients received a transfusion in the postoperative period. Hemoglobin values which predict postoperative transfusions were not significantly different between uTKA and bTKA for both female and male groups. In females, the preoperative hemoglobin threshold was 12.8 g/dL (95 % CI: 12.2-13.3) in patients undergoing bTKA and 12.7 g/dL (95 % CI: 12.2 - 13.2) in uTKA. In males, the threshold was 13.9 (95 % CI: 13.7-14.2) in patients undergoing bTKA and 13.1 g/dL (95 % CI: 12.5-13.8) in patients undergoing uTKA. CONCLUSIONS Preoperative hemoglobin values which maximally predict postoperative transfusion risk following uTKA and bTKA are similar without significant differences.
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Affiliation(s)
- Andrew B Harris
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, United States.
| | - Sasha Narain
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, United States
| | - Alex Gu
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, United States
| | - Matthew Best
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, United States
| | - Savyasachi Thakkar
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, United States
| | - Harpal Khanuja
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, United States
| | - Robert Sterling
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, United States
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Faisaluddin M, Ahmed AZ, Patel H, Thakkar S, Dani S, Alweis R, Feitell S. Gender Disparities in LVAD Utilization: A NIS Database Analysis 2009-2020. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Faisaluddin M, Ahmed AZ, Patel H, Thakkar S, Dani S, Alweis R, Feitell S. Racial and Regional Disparities in Lvad Utilization: A Nis Database Analysis 2009-2020. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Faisaluddin M, Ahmed AIZ, Patel H, Thakkar S, Dani S, Alweis R, Feitell S. Burden of Arrythmias and Hospital Outcomes Among Patients with Heart Transplant: A Nis Database Analysis from 2015-2020. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Faisaluddin M, Ahmed AZ, Patel H, Thakkar S, Dani S, Alweis R, Feitell S. Burden of Arrythmias and Hospital Outcomes Among Patients with Left Ventricular Assisted Device Patients: A Nis Database Analysis from 2015-2020. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Faisaluddin M, Ahmed AZ, Patel H, Thakkar S, Dani S, Alweis R, Feitell S. Gender Disparities in the Heart Transplant Implantation: A Nationwide Study from 2009-2020. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Victor V, Thakkar S, Patel H, Deshmukh A, Desimone C, Feitell SC, Blankstein R. A nationwide analysis of cardiac sarcoidosis and related in-hospital outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Sarcoidosis is a multisystem disorder characterized by an autoimmune response to an unidentified antigen in genetically susceptible persons. Despite clinically detectable cardiac manifestations of sarcoidosis occurring in approximately 5% of patients, recent studies have revealed cardiac involvement to be at 25% in patients with the disease, highlighting the fact that cardiac involvement in sarcoidosis is much more common than was once thought to be.
Purpose
With cardiac involvement in sarcoidosis being increasingly recognized due to the availability of advanced cardiac imaging, large scale data regarding in-hospital mortality and clinical outcomes of patients admitted with cardiac sarcoidosis (CS) is lacking. Our study aimed to fill this knowledge gap by analyzing demographics and in-hospital outcomes of a large cohort of patients admitted with CS across the United States (US).
Methods
We analyzed data from the national inpatient sample (NIS) database between October 2015 to December 2018 to identify patients who had been admitted with primary and secondary diagnoses of CS. The NIS is an administrative database sponsored by the Agency for Healthcare Research and Quality consisting of data from 46 participating states, representing more than 95% of the US population and providing nationwide estimates of over 35 million hospitalizations annually. The NIS uses de-identified hospital discharges as samples and hence no additional ethical committee approval was required. International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code D86.85 was used to identify hospitalizations with CS in patients aged 18 years or older. SAS 9.4 (SAS Institute, Inc, Cary, NC) was used for statistical analyses.
Results
A total of 4275 patients were included in the analysis. A higher proportion of patients with CS were females (62.43% vs. 37.57%). Hypertension was the most common comorbidity (43.99%), followed by hyperlipidemia (39.21%) and chronic kidney disease (26.95%). All-cause in-hospital mortality was 2.57%. Atrial fibrillation (AF) was the most common arrhythmia (28.12%), followed by ventricular tachycardia (VT) (22.52%). About 16% of CS patients underwent implantable cardioverter-defibrillator (ICD) implantation during hospital stay. About 42% of patients had concurrent heart failure, out of whom 33.84% had heart failure with reduced ejection fraction (HFrEF). Mean length of hospital stay was 5 days (3–8 days), and the mean cost of hospitalization was $14,177 ($7,121–35,993).
Conclusion
Given the low prevalence of CS, most of the available studies have been retrospective in nature, based on small sample sizes. Despite being retrospective and cross-sectional, our study has the advantage of being based on a nationally representative sample population, providing key formation on the demographics and in-hospital outcomes of patients with CS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- V Victor
- Aultman Hospital , Canton , United States of America
| | - S Thakkar
- Rochester General Hospital, Internal Medicine , Rochester , United States of America
| | - H Patel
- Louis A. Weiss Memorial Hospital, Internal Medicine , Chicago , United States of America
| | - A Deshmukh
- Mayo Clinic, Electrophysiology , Rochester , United States of America
| | - C Desimone
- Mayo Clinic, Electrophysiology , Rochester , United States of America
| | - S C Feitell
- Rochester General Hospital, Advanced Heart Failure and Transplant Cardiology , Rochester , United States of America
| | - R Blankstein
- Brigham and Women'S Hospital, Harvard Medical School, Cardiology , Boston , United States of America
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Thakkar S, Fowke T, Nicolas A, Nair A, Pontier M, Wevers N. LP-17 Blood-brain barrier on-a-chip to study compound-induced disruption. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Fassihi SC, Lee D, Tran AA, Lee R, Pollard T, Stadecker M, Stake S, Hughes AJ, Thakkar S. Erratum to ‘Total Hip Arthroplasty in An Adult Patient With Pelvic Dysmorphism, Unilateral Sacroiliac Joint Autofusion, and Developmental Hip Dysplasia’ [Arthroplasty Today 6 (2020) 41-47]. Arthroplast Today 2022; 15:235. [PMID: 35774882 PMCID: PMC9237268 DOI: 10.1016/j.artd.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Safa C. Fassihi
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Danny Lee
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Andrew A. Tran
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
- Corresponding author. 2300 M St NW, 5th Floor, Washington, DC 20037, USA. Tel.: +1 408 476 2609.
| | - Ryan Lee
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Tom Pollard
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Monica Stadecker
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Seth Stake
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Alice J. Hughes
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Savyasachi Thakkar
- Department of Orthopaedic Surgery, MedStar Washington Hospital Center, Washington, DC, USA
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Dobek A, Cohen J, Ramamurti P, Gu A, Golladay GJ, Doerre T, Thakkar S. Comparison of Arthroscopy versus Open Arthrotomy for Treatment of Septic Arthritis of the Native Knee: Analysis of 90-Day Postoperative Complications. J Knee Surg 2022. [PMID: 35512823 DOI: 10.1055/s-0042-1747948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Septic arthritis is an orthopaedic emergency, often necessitating surgical debridement, and the knee joint is most frequently affected. Arthroscopic and open irrigation and debridement (I&D) are the two commonest surgical treatments for septic arthritis of the native knee. Several studies have compared outcomes of open and arthroscopic management without coming to a clear conclusion which yields superior outcomes. The purpose of this study was to compare the results of these two surgical techniques to treat septic arthritis of the native knee using a large nationwide database. Patients who underwent arthroscopic or open I&D as treatment for knee septic arthritis from 2010 to 2019 were identified using a national insurance database. The primary outcome was the 90-day reoperation rate. Secondary outcomes included surgical site infection, readmission, and other postoperative complications. A total of 1,139 patients were identified, 618 of whom (54%) underwent open treatment and 521 (46%) underwent arthroscopic treatment. The two groups did not differ significantly by age, gender, or most comorbidities. There was no significant difference in 90-day reoperation rate between the groups (15.0.% open and 18.0% arthroscopic, p = 0.174). Patients who underwent open treatment had increased odds of readmission to the hospital (odds ratio [OR] = 1.46 [1.14-1.86]; p = 0.003), postoperative anemia (OR = 1.71 [1.08-2.75]; p = 0.025), and blood transfusion (OR = 1.76 [1.04-3.06]; p = 0.040) compared with those who underwent arthroscopic surgery. Using administrative claims data, we found that arthroscopic and open I&D have similar rates of reoperation and most 90-day postoperative outcomes. Lower rates of readmission, postoperative anemia, and blood transfusion were found with arthroscopic I&D, suggesting that arthroscopy may be preferable to open treatment in the management of septic arthritis of the native knee in cases in which other case- and surgeon-specific factors do not otherwise dictate the best treatment modality.
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Affiliation(s)
- Alexander Dobek
- Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Jordan Cohen
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pradip Ramamurti
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Alex Gu
- Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Gregory J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health, Richmond, Virginia
| | - Teresa Doerre
- Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Savyasachi Thakkar
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Columbia, Maryland
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Easwaran R, Khan M, Sancheti P, Shyam A, Bhandari M, Ranawat AS, Thakkar S, Parikh S, Musahl V, Joglekar S, J Deshmukh A, Plancher K, Verma N, McAllister D, Verdonk P, Lustig S, Chandrateya A, Smigleiski R, Solayar G, Chernchujit B, Yung P, Budhiparama N, Hoshino Y, White N, Parker D, Clatworthy M, Brown C, Manzary M, Rajan D, Narvekar A, Tapasvi S, Pardiwala D, Panigrahi R, Arumugam S, Kapoor V, Mody B, Maheshwari J, Dahiya V, Joseph C, Laddha M, Rajgopal A. Prophylaxis for preventing venous thromboembolism in knee arthroscopy and soft tissue reconstruction: consensus statements from an international panel of experts. Knee Surg Sports Traumatol Arthrosc 2022; 30:3634-3643. [PMID: 35435469 PMCID: PMC9013735 DOI: 10.1007/s00167-022-06973-w] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/29/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE There is a lack of consensus regarding need for Venous Thrombo Embolism (VTE) prophylaxis following arthroscopic knee surgery and open soft tissue knee reconstruction. Clear cut guidelines like ones for trauma surgery and arthroplasty do not exist and the published literature is limited to case reports with a few society guidelines. Given this lack of consensus, we conducted a modified Delphi questionnaire of international experts to provide recommendations on this topic. METHODS The consensus statements were generated using an anonymised 3 round modified Delphi questionnaire, sent to an international panel of 38 knee surgeons, with an 80% agreement being set as the limit for consensus. The responses were analysed using descriptive statistics with measures like mode, median and box plots. Feedback was provided to all panelists based on responses from the previous rounds to help generate the consensus. RESULTS Six consensus statements were generated after the three rounds of Delphi. Patient factors, prolonged surgery duration and family history of thrombogenic events emerged as the main points to be taken into consideration for prophylaxis. CONCLUSION It was established through this study, that there exists a select group of patients undergoing arthroscopic surgery that justify the usage of VTE prophylaxis. The expert responses to most of the questions in different scenarios favoured usage of VTE prophylaxis based on patient factors like advanced age, past history of VTE, smoking, oral contraceptive use etc. LEVEL OF EVIDENCE: Level V.
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Affiliation(s)
- Raju Easwaran
- Shree Meenakshi Orthopedics and Sports Medicine Clinic, B H 41 East, Shalimar Bagh, New Delhi, 110088, India.
- Department of Arthroscopy and Sports Injuries, Max Super-Speciality Hospital Shalimar Bagh, New Delhi, India.
| | - Moin Khan
- Sports Medicine and Shoulder Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - Parag Sancheti
- Sancheti Institute for Orthopaedics and Rehabilitation and PG College, Pune, India
| | - Ashok Shyam
- Sancheti Institute for Orthopedics and Rehabilitation, Pune, India
| | - Mohit Bhandari
- Chair, Department of Surgery, McMaster University, Hamilton, Canada
| | - Anil S Ranawat
- Knee Division of SMI, Hospital for Special Surgery, New York, USA
| | - Savyasachi Thakkar
- Johns Hopkins Orthopaedics, Hip and Knee Reconstruction Surgery, Columbia, USA
| | - Shital Parikh
- Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Volker Musahl
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, USA
| | - Siddharth Joglekar
- Orthopedic Service, VA Central California Health Care System, Fresno, CA, USA
- UCSF Fresno Orthopedic Residency Program, Fresno, USA
| | | | - Kevin Plancher
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, NY, USA
- Weill Cornell Medical College, New York, USA
- Orthopaedic Foundation, Stamford, CT, USA
- Plancher Orthopaedics and Sports Medicine, New York, USA
| | - Nikhil Verma
- Division of Sports Medicine, Sports Medicine Fellowship, Rush University Medical Center, Midwest Orthopedics at Rush, Chicago, USA
| | - David McAllister
- Sports Medicine Service, Vice Chair of Academic Affairs, Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, USA
- UCLA Department of Athletics, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Peter Verdonk
- Orthopaedic Center Antwerp, Antwerp, Belgium
- Department of Orthopaedic Surgery, Antwerp University, Antwerp, Belgium
| | - Sebastien Lustig
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, Lyon, France
| | - Amit Chandrateya
- Princess of Wales Hospital Bridgend, Cwm Taf Morgannwg University Health Board, Bridgend, UK
| | - Robert Smigleiski
- Orthopaedics and Sports Medicine, Department at LIFE Institute, LIFE Institute Biological Treatment Centre, Warsaw, Poland
| | - Gandhi Solayar
- Orthopaedic Specialist Centre, Subang Jaya, Selangor, Malaysia
| | - Bancha Chernchujit
- Department of Orthopedics, Thammasat University Hospital, Khlong Nueng, Thailand
| | - Patrick Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong, China
| | - Nicolaas Budhiparama
- School of Vocational Studies and Department of Orthopaedics and Traumatology, School of Medicine, University of Airlangga, Jl. Mayjend. Prof. Dr. Moestopo, Jawa Timur, Indonesia
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine, Medistra Hospital, Jakarta, Indonesia
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, School of Medicine, Kobe University, Kobe, Japan
| | | | - David Parker
- Sydney Orthopaedic Research Institute, Chatswood, Australia
| | | | - Charlie Brown
- International Knee and Joint Centre, Abu Dhabi, United Arab Emirates
| | - Mojieb Manzary
- Orthopedic Services, Johns Hopkins Aramco Health Care Center, Dhahran, Saudi Arabia
- Department of Orthopedics, Johns Hopkins University School of Medicine, Dhahran, Saudi Arabia
| | - David Rajan
- Ortho One-Orthopaedic Speciality Centre, Coimbatore, India
| | - Abhay Narvekar
- P D Hinduja Hospitals Mumbai, Global Hospital Parel, Mumbai, India
| | | | - Dinshaw Pardiwala
- Arthroscopy Service, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | - Ranjit Panigrahi
- PG Dept of Orthopaedics, Hitech Medical College and Hospital, Bhubaneswar, Odisha, India
- Kalinga Super Speciality Hospital, Bhubaneswar, Odisha, India
| | - S Arumugam
- Centre for Sports Science, Sri Ramachandra Institute of Higher Education and Research (Deemed University), Chennai, India
| | - Vikash Kapoor
- Medica Superspeciality Hospital, Medica Hospitals, Kolkata, India
| | - Bharat Mody
- Welcare Hospital, Atladra-Vadsar Ring Road, Atladra, Vadodara, Gujarat, India
| | - Jitender Maheshwari
- Knee and Shoulder Service, Department of Orthopaedics, Sitaram Bharatiya Hospital, New Delhi, India
| | - Vivek Dahiya
- Adult Reconstruction Lower Limb, Institute of Musculoskeletal Disorders and Orthopaedics, Medanta, Gurugram, India
| | - Clement Joseph
- Arthroscopy and Sports Medicine, Asian Joint Reconstruction Institute, SIMS, Chennai, India
| | | | - Ashok Rajgopal
- Institute of Musculoskeletal Diseases and Orthopaedics, Medanta Medicity, Gurugram, Haryana, India
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Ifarraguerri AM, Malyavko A, Stoll WT, Patel S, Thakkar S. Impact of human immunodeficiency virus on 2-year revision rates following lumbar fusion for degenerative spinal conditions: a retrospective cohort study. J Spine Surg 2021; 7:475-484. [PMID: 35128121 PMCID: PMC8743293 DOI: 10.21037/jss-21-84] [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] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/13/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND To our knowledge, no studies exist that evaluate the impact of human immunodeficiency virus (HIV) on long-term revision rates following lumbar fusion. This study aims to understand how HIV impacts 2-year revision rates and 90-day postoperative complication rates following primary lumbar fusion for degenerative spine conditions. METHODS Data collection was done using PearlDiver Patient Records Database, a national insurance database from 2010-2019. Patients who underwent primary lumbar fusion for degenerative diseases were divided into a cohort of patients that are HIV positive (HIV), have asymptomatic HIV (AHIV), acquired immune deficiency syndrome (AIDS), and HIV-negative at the time of their procedure. Univariate and multivariable regression analyses were performed to determine rates of revision surgery, surgical site infection (SSI), neurological complications, sensory deficits, bowel/bladder dysfunction and myelopathies within two years of surgery as well as 90-day postoperative complications. RESULTS In total, 216,587 patients were included in this study. Of these, 631 patients (0.29%) had HIV including 502 patients (0.23%) with asymptomatic HIV and 129 patients (0.06%) with AIDS. Relative to the control cohort, patients with HIV had no difference in odds of two-year revision surgery, SSI, neurological complications, sensory deficits, bowel/bladder dysfunction and myelopathies. Patients with HIV did have increased odds of postoperative pneumonia (OR 1.592; 95% CI: 1.048-2.314; P=0.021). AIDS patients had greater odds of respiratory complications (OR 2.585; 95% CI: 1.075-5.264; P=0.017) and septic complications (OR 2.702; 95% CI: 1.122-5.514; P=0.013) 90-day postoperatively. CONCLUSIONS Our study found that HIV positive status did not significantly affect two-year revision rates compared to the control group. However, there is a higher rate of pneumonia and respiratory complications among HIV positive patients. Before deciding to proceed with surgical intervention in HIV positive individuals, surgeons must carefully consider each patient's specific diagnosis, comorbidities, and risk factors.
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Affiliation(s)
- Anna Maria Ifarraguerri
- Department of Orthopaedic Surgery, George Washington University Hospital, Washington, DC, USA
| | - Alisa Malyavko
- Department of Orthopaedic Surgery, George Washington University Hospital, Washington, DC, USA
| | - W. Travis Stoll
- Department of Orthopaedic Surgery, George Washington University Hospital, Washington, DC, USA
| | - Shalin Patel
- Department of Orthopaedic Surgery, George Washington University Hospital, Washington, DC, USA
| | - Savyasachi Thakkar
- Department of Orthopaedic Surgery, Adult Reconstruction Division, Johns Hopkins University, Columbia, MD, USA
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15
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Wei C, Quan T, Wang KY, Gu A, Fassihi SC, Kahlenberg CA, Malahias MA, Liu J, Thakkar S, Gonzalez Della Valle A, Sculco PK. Artificial neural network prediction of same-day discharge following primary total knee arthroplasty based on preoperative and intraoperative variables. Bone Joint J 2021; 103-B:1358-1366. [PMID: 34334050 DOI: 10.1302/0301-620x.103b8.bjj-2020-1013.r2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS This study used an artificial neural network (ANN) model to determine the most important pre- and perioperative variables to predict same-day discharge in patients undergoing total knee arthroplasty (TKA). METHODS Data for this study were collected from the National Surgery Quality Improvement Program (NSQIP) database from the year 2018. Patients who received a primary, elective, unilateral TKA with a diagnosis of primary osteoarthritis were included. Demographic, preoperative, and intraoperative variables were analyzed. The ANN model was compared to a logistic regression model, which is a conventional machine-learning algorithm. Variables collected from 28,742 patients were analyzed based on their contribution to hospital length of stay. RESULTS The predictability of the ANN model, area under the curve (AUC) = 0.801, was similar to the logistic regression model (AUC = 0.796) and identified certain variables as important factors to predict same-day discharge. The ten most important factors favouring same-day discharge in the ANN model include preoperative sodium, preoperative international normalized ratio, BMI, age, anaesthesia type, operating time, dyspnoea status, functional status, race, anaemia status, and chronic obstructive pulmonary disease (COPD). Six of these variables were also found to be significant on logistic regression analysis. CONCLUSION Both ANN modelling and logistic regression analysis revealed clinically important factors in predicting patients who can undergo safely undergo same-day discharge from an outpatient TKA. The ANN model provides a beneficial approach to help determine which perioperative factors can predict same-day discharge as of 2018 perioperative recovery protocols. Cite this article: Bone Joint J 2021;103-B(8):1358-1366.
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Affiliation(s)
- Chapman Wei
- Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Theodore Quan
- Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Kevin Y Wang
- Johns Hopkins Department of Orthopaedic Surgery, Adult Reconstruction Division, John Hopkins Medicine, Baltimore, Maryland, USA
| | - Alex Gu
- Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.,The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, Washington, District of Columbia, USA
| | - Safa C Fassihi
- Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Cynthia A Kahlenberg
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Michael-Alexander Malahias
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Jiabin Liu
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Savyasachi Thakkar
- Johns Hopkins Department of Orthopaedic Surgery, Adult Reconstruction Division, John Hopkins Medicine, Baltimore, Maryland, USA
| | - Alejandro Gonzalez Della Valle
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, Washington, District of Columbia, USA
| | - Peter K Sculco
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, Washington, District of Columbia, USA
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Malyavko A, Kim Y, Harmon TG, Quan T, Gu A, Bernstein SA, Tabaie SA, Thakkar S. Utility of Social Media for Recruitment by Orthopaedic Surgery Residency Programs. JB JS Open Access 2021; 6:e21.00076. [PMID: 34514283 PMCID: PMC8423379 DOI: 10.2106/jbjs.oa.21.00076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND As the use of social media continues to rise, the presence of social media accounts among orthopaedic surgery residency programs can foster connections with other specialties, highlight departmental achievements, and be a resource for applicants to learn more about the program. This study evaluated the current utility and landscape of social media, with an emphasis on the use of Instagram, in orthopaedic surgery residency programs in the United States. METHODS A cross-sectional study of orthopaedic surgery residency Instagram accounts was performed. The Instagram accounts were evaluated for the number of followers, number of accounts following, and number of posts. Instagram posts were further categorized into academic, departmental, education, and COVID-19-related content. In addition, a search was performed to identify the presence of Twitter and Facebook accounts among orthopaedic surgery residency programs. Bivariate and multivariable logistic regression models were used to analyze the data in this study. RESULTS Of the 192 orthopaedic surgery residency programs evaluated, 108 programs (56%) had an Instagram account, 65 programs (34%) had a Twitter account, and 58 programs (30%) had a Facebook account. Of the 108 programs with an Instagram account, 92 accounts (85%) were created in 2020. A higher Doximity ranking of a program was positively associated with the presence of an Instagram account (p < 0.001). A significant correlation was found between the number of posts and the Instagram engagement score (p = 0.018). The majority of Instagram posts contained departmental content (54%) followed by social (13%) and COVID-19-related (10%) content. CONCLUSIONS The presence of orthopaedic surgery residency programs on social media has grown significantly in the year 2020. With the presence of more than 50% of residency programs on Instagram, this can be a useful resource for prospective applicants and other healthcare professionals to gain insight into the activities of orthopaedic surgery residency programs across the United States.
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Affiliation(s)
- Alisa Malyavko
- Department of Orthopaedic Surgery, George Washington Hospital, Washington, District of Columbia
| | - Yumin Kim
- Department of Orthopaedic Surgery, George Washington Hospital, Washington, District of Columbia
| | - Tara G. Harmon
- Department of Orthopaedic Surgery, George Washington Hospital, Washington, District of Columbia
| | - Theodore Quan
- Department of Orthopaedic Surgery, George Washington Hospital, Washington, District of Columbia
| | - Alex Gu
- Department of Orthopaedic Surgery, George Washington Hospital, Washington, District of Columbia
| | - Simone A. Bernstein
- Department of Psychiatry, Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, Missouri
| | - Sean A. Tabaie
- Department of Orthopaedics and Sports Medicine, Children’s National Health Systems, Washington, District of Columbia
| | - Savyasachi Thakkar
- Johns Hopkins Department of Orthopaedic Surgery, Adult Reconstruction Division, Columbia, Maryland
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Silverman S, Schepman P, Rice JB, Beck C, White A, Thakkar S, Johnson M, Robinson R, Emir B. POS0283 TREATMENT PATTERNS AND CLINICAL CHARACTERISTICS OF PATIENTS WITH OSTEOARTHRITIS OF THE HIP AND/OR KNEE TREATED WITH TRADITIONAL NSAIDS VS COX-2S: A REAL-WORLD STUDY OF COMMERCIALLY-INSURED PATIENTS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The 2019 American College of Rheumatology (ACR) guidelines strongly recommend oral nonsteroidal anti-inflammatory drugs (NSAIDs) for management of hip and knee osteoarthritis (OA) and strongly recommend topical NSAIDs for knee OA. There are, however, important safety considerations with NSAIDs in terms of increased rates of gastrointestinal, cardiovascular, and renal events. Given these risks, it is important to understand the characteristics and drug utilization of the patients who start treatment on these different treatments (i.e., traditional NSAIDs [tNSAIDs] and cyclooxygenase-2 inhibitors [COX-2s]).Objectives:The goal of this research was to describe and compare baseline characteristics of commercially-insured patients diagnosed with OA of the hip and/or knee who started treatment on different types of NSAIDs (i.e., oral tNSAIDs, topical tNSAIDs, and COX-2s).Methods:The Optum Healthcare Solutions, Inc. claims database (1/2012-3/2017) was used to identify patients ≥18 years old, with ≥2 diagnoses of hip and/or knee OA, and ≥90 days supply of oral tNSAIDs, topical tNSAIDs, or COX-2s during the one-year follow up period. The index date was defined as the first prescription after the first OA diagnosis. Patients were assigned to cohorts based on the type of NSAID prescribed on index date. Patients were required to be continuously-enrolled six months before (baseline period) and 36 months after (follow-up period) the index date. Demographic and clinical characteristics including age, sex, comorbidities, and healthcare resource use (HRU) were summarized during baseline. Drug utilization characteristics including days supply and number of prescriptions for the different NSAIDs types were summarized during follow-up period.Results:Data for 23,796 patients were analyzed: 18,100 patients received oral tNSAIDs, 4,825 received COX-2s, and 871 topical tNSAIDs. Patients who initiated treatment on oral tNSAIDs were the youngest (mean age of 60.6 vs. 64.6 for COX-2s and 65.0 for topical tNSAIDs) and topical tNSAIDs had the highest proportion of female patients (71% vs. 62% for oral tNSAIDs and 63% for COX-2s). The topical tNSAIDs cohort had the highest presence of chronic kidney disease (2.6% vs. 1.0% and 1.5% for oral tNSAIDs and COX-2s, respectively) and congestive heart failure (2.5% vs. 0.8% and 1.7% for oral tNSAIDs and COX-2s, respectively) at baseline. In terms of HRU during baseline, topical tNSAIDs had the most patients with emergency department visits (20.8% vs. 16.7% in both COX-2s and oral tNSAIDs), and COX-2 had the most patients with inpatient visits (18.1% vs. 15.4% for topical tNSAIDs and 11.8% for oral tNSAIDs). Oral tNSAIDs had the lowest total all-cause cost ($6,504), and the topical tNSAIDs cohort had the highest costs ($8,455), but fairly comparable with COX-2s ($8,289). During follow-up, oral tNSAIDs patients stayed mostly on oral tNSAIDs as less than 15% of oral tNSAIDs patients later had a prescription for COX-2s or topical tNSAIDs. 37% of COX-2 patients and 56% of topical tNSAIDs patients later took oral tNSAIDs. Topical tNSAIDs patients had an average of 184.4 days of supply for topical tNSAIDs yet also extensively used oral NSAIDs during follow-up (average days of supply for oral tNSAIDs was 315.5 days and for COX-2s was 383.5 days).Conclusion:This study suggests that patients with more complex comorbidity profiles, including higher rates of adverse effects, often start pharmacological treatment with topical tNSAIDs. However, patients who start treatment with topical tNSAIDs switch to other types of NSAIDs; oral tNSAIDs were the most frequently prescribed treatment across the cohorts. Thus, despite the safety concerns with oral tNSAIDs and COX-2s, patients are still placed on these treatments to manage their OA pain. There is a need for new innovative treatments as there is currently a lack of other options.Disclosure of Interests:Stuart Silverman Consultant of: Stuart Silverman is a paid consultant to Pfizer and Eli Lilly and Company in connection with this study, Patricia Schepman Shareholder of: Patricia Schepman is an employee of Pfizer with stock and/or stock options, Employee of: Pfizer, James B Rice Consultant of: Brad Rice is an employee of Analysis Group, who were paid consultants to Pfizer and Eli Lilly and Company for this study, Craig Beck Shareholder of: Craig Beck is an employee of Pfizer with stock and/or stock options, Employee of: Pfizer, Alan White Consultant of: Alan White is an employee of Analysis Group, who were paid consultants to Pfizer and Eli Lilly and Company for this study, Sheena Thakkar Shareholder of: Sheena Thakkar is an employee of Pfizer with stock and/or stock options, Employee of: Pfizer, Michaela Johnson Consultant of: Michaela Johnson is an employee of Analysis Group, who were paid consultants to Pfizer and Eli Lilly and Company for this study, Rebecca Robinson Shareholder of: Rebecca Robinson is an employee and minor stockholder of Eli Lilly and Company, Employee of: Eli Lilly and Company, Birol Emir Shareholder of: Birol Emir is an employee of Pfizer with stock and/or stock options, Employee of: Pfizer
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Sadosky A, Schepman P, Thakkar S, Robinson R, Beck C. AB0035 A REVIEW OF THE CLINICAL AND ECONOMIC BURDEN OF OSTEOARTHRITIS PAIN BY SEVERITY IN THE UNITED STATES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The development of new therapies to treat symptomatic osteoarthritis (OA) often requires targeting patient subgroups such as mild and/or moderate and/or severe. Multiple assessments for pain are used in clinical and research settings, yet to quantify patient burden with increasing pain severity it is important to understand the potential variability in outcomes based on definitions of severity used1.Objectives:The objective of this study was to examine studies in the published literature that report the burden of OA pain by severity to assess similarities and/or differences across study methodologies and outcomes.Methods:A targeted literature review of PubMed and Google Scholar was conducted January 2021 and included search terms: osteoarthritis, severity, United States (US), burden, quality of life, medication/treatment, and healthcare resource utilization. The search was limited to the English language, full-text articles, and no restriction on publication date. Results included a recent study of the burden of symptomatic OA pain respondents by severity level in the US2,3. Over 100 publication titles were reviewed. Comparison of findings was descriptive in nature.Results:Nine publications were identified representing 7 unique studies, 6 being patient and/or healthcare provider surveys. Two studies focused on OA severity: the remaining 5 stratified patients by pain severity, and all but 2 of the 5 identified and confirmed pain as OA-related. Pain measures included numeric rating scales (generic 0-10, Western Ontario and McMaster Universities Arthritis Index [WOMAC] NRS 3.1), visual analog scales (generic 0-100, Short-Form McGill Pain Questionnaire Visual Analog Scale [SF-MPQ-VAS]) or Pain Interference with Activities (PIA) scale derived from the 12-Item Short Form Health Survey [SF-12v2] developed for the Medical Outcomes Study, with recall periods varying from 48 hours to 7 days to 4 weeks. Only one study exclusively assessed symptomatic patients only i.e., patients with pain scores of 0 were excluded; the remainder compared cohorts of no/mild pain with increasing severity cohorts. Four of the 7 studies examined pairwise differences among mild, moderate, and severe patients (1 study vs. a non-OA cohort); 2 compared no/mild vs. moderate-to-severe OA pain and 1 study compared mild to moderate-to-severe OA pain. For most outcomes examined like clinical comorbidities, quality of life, and healthcare resource utilization, increasing burden was observed with increasing OA and/or pain severity despite study variability.Conclusion:Pain severity levels represent an important and distinguishing factor that contributes to health outcomes in OA patients in the US. Considerable heterogeneity across studies may impact how OA pain is defined, perceived by patients, and treated. Selecting appropriate OA pain severity assessments, including cut-points, may contribute to the successful monitoring of outcomes or comparisons of therapies to manage symptomatic OA pain, especially those that target specific pain severity subgroups.References:[1]Hawker GA, Mian S, Kendzerska T et al. Arthritis Care and Research. 2011; 63(11):S240-S252.[2]Schepman P, Robinson RL, Thakkar S, et al. International Society of Pharmacoeconomics and Outcomes Research (ISPOR) Virtual Annual Meeting; May 2020.[3]Schepman P, Thakkar S, Robinson RL, et al. PAINWeek 2020 Virtual Meeting; September 2020.Disclosure of Interests:Alesia Sadosky Shareholder of: Own stock in Pfizer Inc, Consultant of: I am an employee with the consulting firm Apperture Health, Employee of: I am retired from Pfizer Inc, Patricia Schepman Shareholder of: Owns shares in Pfizer Inc, Employee of: Employee of Pfizer Inc, Sheena Thakkar Shareholder of: Owns shares of Pfizer Inc, Employee of: Employee of Pfizer Inc, Rebecca Robinson Shareholder of: Owns shares of Eli Lilly and Company, Employee of: Employee of Eli Lilly and Company, Craig Beck Shareholder of: Owns shares of Pfizer Inc, Employee of: Employee of Pfizer Inc
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Rai D, Anjum Z, Tahir M, Pandey R, Thakkar S, Zaheer A, Feitell S, Khodjaev S, Lee E, Parikh V. “Clots and Failures” A Case of COVID-19 Causing STEMI and Persistent Cardiogenic Shock Ultimately Requiring LVAD. J Heart Lung Transplant 2021. [PMCID: PMC7979404 DOI: 10.1016/j.healun.2021.01.2130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction We present a case of COVID-19 causing hypercoagulability and inflammatory stress leading to STEMI in a patient who went on to develop persistent cardiogenic shock requiring LVA) implantation. Case Report 57-year-old lady developed COVID-19 infection in May 2020. In June 2020, she presented with chest pain, was noted to have STEMI on EKG, complicated by cardiac arrest with ROSC in 14 minutes. She was in cardiogenic shock as well and was started on veno-arterial ECMO. She underwent left anterior descending artery stent placement. Further hospitalization was complicated by persistent cardiogenic shock and complete heart block and underwent pacemaker and cardiac-defibrillator implantation. She developed pulmonary edema, acute kidney injury requiring hemodialysis, shock liver, and persistent cardiogenic shock. She was weaned off VA-ECMO after 4 days but continued to have severely reduced cardiac function. RHC revealed severe volume overload, pulmonary venous hypertension, low cardiac output, and right heart dysfunction. Echo showed severe LV dysfunction with an EF of 15%. A femoral intra-aortic balloon pump(IABP) was placed on July 7, 2020. An attempt was made to wean her off of IABP on July 10th,however, it was unsuccessful and she was transitioned to axillary intra-aortic balloon pump. She remained IABP dependent thereafter and on July 15th, given persistent cardiogenic shock, decision was made to pursue advanced heart failure therapies. After multi-disciplinary discussion, the decision to pursue LVAD implantation was made. She underwent a successful LVAD implantation on July 20th . She failed an extubation trial and underwent tracheostomy on July 23rd . Post LVAD, she developed atrial fibrillation and was started on digoxin and amiodarone. Her symptoms improved and she was subsequently discharged to rehabilitation in late August on amiodarone, digoxin, metoprolol, prasugrel, warfarin, spironolactone and lisinopril. The detailed timeline is shown in figure 1. Summary Hypercoagulability and severe inflammatory stress leading to life-threatening illness is a significant complication of COVID-19 infection. A low threshold for suspecting and treating hypercoagulability and inflammatory induced myocardial ischemia and injury and cardiogenic shock is a reasonable strategy to decrease acute as well as chronic morbidity and mortality.
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Rai D, Tahir M, Pandey R, Kharsa A, Furqan F, Thakkar S, Zaheer A, Khodjaev S, Feitell S, Lee E, Parikh V. ECMO for Critically Ill COVID-19 with ARDS: A Case Series. J Heart Lung Transplant 2021. [PMCID: PMC7979398 DOI: 10.1016/j.healun.2021.01.2133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction Veno-venous extracorporeal membrane oxygenation (VV-ECMO) as bridge to recovery in critically ill COVID-19 continues to be commonly utilized strategy in cases with persistent respiratory failure refractory to traditional ventilation support Case Report We report 5 cases of severe acute respiratory syndrome coronavirus-2 infection (SARS-CoV-2) who were treated with ECMO (Table 1). All 5 cases presented with fever, cough and shortness of breath and a positive nasopharyngeal swab for SARS-CoV-2 on admission. Case 1, 2, 3 and 5 patients were hypoxemic with saturation less than 90% on admission and decompensated rapidly, whereas Case 4 decompensated after day 14. Mechanical ventilation failed to provide adequate oxygenation in all 5 cases; case 2,3 and 5 were started on recruitment measures with proning while it was not possible for case 1 owing to morbid obesity. Proning was not possible in the case 4 as patient became severely hypoxemic while patient was undergoing mechanical thrombectomy. The case 1-4 remained on ECMO for 19, 17, 17 and 2 days respectively. All except case 2 had improvement in APACHEII and SOFA score after ECMO initiation. All 5 patients had elevated inflammatory markers of serum ferritin, D-dimer, Lactate dehydrogenase (LDH), C-reactive protein (CRP) which trended down after a few days of ECMO initiation All 5 patients received high dose steroids during their stay in the ICU. Case 4 and 5 passed away after compassionate extubation. Case 1-3 had prolonged hospital course with complication of hospital acquired pneumonia requiring multiple courses of broad-spectrum antibiotics. Summary Our observational report of 5 patients reports the use of ECMO in critically ill SARS-CoV-2 with ARDS and difficult to maintain saturation despite mechanical ventilation and proning with recovery for 3 patients. However, given the lack of ECMO centers; this is not a readily available option. Further studies are warranted to investigate the role of ECMO in SARRS-CoV-2 and careful identification of appropriate candidates.
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21
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Kumar A, Shariff M, Thakkar S, Doshi R. Oral anticoagulant monotherapy compared to oral anticoagulant plus single anti-platelet therapy in stable ischemic heart disease with atrial fibrillation: a meta-analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Evidence for antithrombotic therapy regimen in patients with concurrent stable ischemic heart disease (SIHD) and atrial fibrillation (AF) is not well established. The ideal regimen needs to been balanced to prevent thrombotic and embolic events, without increasing the risk of bleeding tendencies. Two randomized control trials have been published studying oral anticoagulant monotherapy (OAC) as compared to oral anticoagulant plus single antiplatelet therapy (OAC+SAPT), of which one trial was terminated prematurely and was underpowered.
Purpose
We performed a meta-analysis of RCTs and observational studies comparing OAC monotherapy to OAC+ SAPT in SIDH patients with AF.
Methods
We performed a systematic search of the PubMed, EMBASE and Cochrane databases to identify relevant articles. The database search was performed from the inception of the databases to January 2020. Inclusion criteria were RCTs and observation studies comparing OAC to OAC+SAPT in SIDH patients with AF and reporting time to event outcomes of major bleeding or cardiovascular mortality. The definition of major bleeding as per the definition provided by individual studies. Two authors independently performed data extraction to check for reproducibility. We used inverse variance method with random effect model to calculate hazard ratio (HR) with 95% confidence interval (CI). Statistical heterogeneity was calculated using Higgins I2 statistics. All statistical analysis was performed using RevMan Version 5.3 (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014).
Results
Seven studies (2 RCTs and 5 observational studies) were included in the final analysis. OAC+ SAPT as compared to OAC monotherapy in patients with SIHD and AF was associated with a higher incidence of major bleeding [HR: 1.59, 95% CI: 1.36–1.85, P value<0.05, I2: 0%] [Figure 1, Panel A]. OAC+SPT as compared to OAC monotherapy was associated with similar incidence of cardiovascular mortality [HR: 1.07, 95% CI: 0.86–1.33, P value= 0.55, I2: 32%] [Figure 1, Panel B]. There was no statistical heterogeneity associated with either pooled estimates.
Conclusion
OAC monotherapy as compared to OAC+SAPT in patients with SIHD and AF was associated with a lower incidence of major bleeding and similar incidence of cardiovascular mortality.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Kumar
- St John's Medical College Hospital, Bangalore, India
| | - M Shariff
- St John's Medical College Hospital, Bangalore, India
| | - S Thakkar
- Rochester Regional Health, Department of Internal Medicine, Rochester, United States of America
| | - R Doshi
- University of nevada, Department of Internal Medicine, Reno, United States of America
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22
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Arora S, P Patel H, Jani C, Thakkar S, Gonzalez J, Deshmukh A, Patel R, D'Hoit B. Impact of catheter ablation for atrial flutter on mortality and hospital readmission rates in patients with heart failure and reduced ejection fraction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The effectiveness of catheter ablation as a management modality amongst patients with coexisting atrial flutter (AFL) and heart failure with reduced ejection fraction (HFrEF) is scarcely studied.
Methods
Appropriate ICD 10 codes were applied to the 2016 and 2017 National Readmission Database (NRD) to isolate patients having coexistent AFL and HFrEF including who had undergone an ablation. All-cause mortality at the end of 1 year was used as a primary outcome. Readmission due to AFL, heart failure (HF) and other causes were secondary outcomes. The hazard ratios were generated using Cox regression analysis while the time to event analysis was demonstrated with the Kaplan Meier curves.
Results
Out of a total of 9966 patients with AFL and HFrEF, 1980 (24.79%) patients underwent catheter ablation. The primary outcome, all-cause mortality (2.8% vs. 4.6%, HR: 0.610, 95% CI: 0.460–0.808, p=0.001) at the end of 1 year was significantly lower. Significant difference was also noted amongst two groups when it came to secondary outcomes such as readmissions due to AFL (1.6% vs. 6.3%, HR: 0.247, 95% CI: 0.173–0.354, p<0.001), HF (8.2% vs. 11.4%, HR: 0.693, 95% CI: 0.587–0.819, p<0.001) and other causes (29.4% vs. 37.1%, HR: 0.735, 95% CI: 0.673–0.804, p<0.001)
Conclusion
Ablative intervention amongst AFL patients with concomitant HFrEF showed a significant reduction in all-cause mortality. It also leads to significant reductions in readmissions due to AFL, HF and other causes at the end of one year.
Outcomes of AFL and HFrEF
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Arora
- Harrington Heart and Vascular institute/University Hospitals Cleveland Medical Center, Cardiovascular Diseases, Cleveland, United States of America
| | - H P Patel
- Louis A. Weiss Memorial Hospital, Internal Medicine, Chicago, United States of America
| | - C Jani
- Mount Auburn Hospital, Internal Medicine, Cambridge, United States of America
| | - S Thakkar
- Rochester General Hospital, Internal Medicine, Rochester, United States of America
| | - J Gonzalez
- Miami Cardiac and Vascular Institute, Cardiovascular Disease, Miami, United States of America
| | - A Deshmukh
- Mayo Clinic, Cardiovascular Disease, Rochester, United States of America
| | - R Patel
- Louis A Weiss Memorial Hospital, Internal Medicine, chicago, United States of America
| | - B D'Hoit
- Harrington Heart and Vascular institute/University Hospitals Cleveland Medical Center, Cardiovascular Disease, Cleveland, United States of America
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Thakkar S, Jani C, P Patel H, Arora S, Patel R, Kumar A, Gonzalez J, Deshmukh A, Rao M. Impact of catheter ablation for atrial flutter on mortality and hospital readmission rates in patients with heart failure and preserved ejection fraction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The availability of real-world data regarding the impact of the catheter ablation in patients with concomitant atrial flutter (AFL) and heart failure with preserved ejection fraction (HFpEF) is limited.
Methods
2016 and 2017 National Readmission Database (NRD) was subjected to appropriate ICD-10 codes to identify and extract patients having coexistent atrial flutter and heart failure with preserved ejection fraction including who had undergone ablation. At 1 year, all-cause mortality was utilized as the primary outcome while readmissions due to AFL, heart failure (HF) and any other causes were designated as secondary outcomes. Kaplan Meier curves were used for a time to event analysis. Cox proportional hazard regression was used to generate hazard ratios.
Results
Out of a total 6099 patients with AFL and HFpEF, 906 (14.85%) underwent catheter ablation. At 1 year all cause mortality (3%, vs. 4.4%, HR: 0.661, 95% CI: 0.444–0.985, p=0.042) and readmissions due to AFL (2.3% vs. 5.3%, HR: 0.424, 95% CI: 0.272–0.661, p<0.001) were significantly less among ablation group. Readmission due to HF (9.3% vs. 9.7%, HR: 0.938, 95% CI: 0.745–1.182, p=0.587) and other causes (37% vs.40.3%, HR: 0.926, 95% CI: 0.825–1.040, p=0.193) did not show any significant difference in outcomes at the end of 1 year.
Conclusion
The utilization of catheter ablation amongst AFL patients with concomitant HFpEF showed a significant reduction in all-cause mortality and readmission due to AFL. However, it did not show any significant changes in readmissions due to HF or other causes at the end of one year.
Outcomes of AFL and HFpEF
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Thakkar
- Rochester General Hospital, Internal Medicine, Rochester, United States of America
| | - C Jani
- Mount Auburn Hospital, Internal Medicine, Cambridge, United States of America
| | - H P Patel
- Louis A. Weiss Memorial Hospital, Internal Medicine, Chicago, United States of America
| | - S Arora
- University Hospitals Case Medical Center, Divison of cardiovascular, Cleveland, United States of America
| | - R Patel
- Louis A. Weiss Memorial Hospital, Internal medicine, Chicago, United States of America
| | - A Kumar
- St John's Medical College Hospital, Critical care, Bangalore, India
| | - J Gonzalez
- Baptist Health South Florida, Cardiovascular Diseases, Miami, United States of America
| | - A Deshmukh
- Mayo Clinic, Cardiovascular Disease, Rochester, United States of America
| | - M Rao
- Rochester General Hospital, Cardiovascular Diseases, Rochester, United States of America
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Tan BEX, Tan JL, Abu Sheika M, Thakkar S, von Doenhoff L. A ticking time bomb: thrombus straddling a patent foramen ovale. QJM 2020; 113:483-484. [PMID: 31995203 DOI: 10.1093/qjmed/hcaa016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- B E-X Tan
- Department of Internal Medicine, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY 14621, USA
| | - J L Tan
- Department of Internal Medicine, Crozer-Chester Medical Center, 1 Medical Center Blvd, Upland, PA 19013, USA
| | - M Abu Sheika
- Department of Internal Medicine, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY 14621, USA
| | - S Thakkar
- Department of Internal Medicine, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY 14621, USA
| | - L von Doenhoff
- Department of Internal Medicine, Division of Cardiology, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY 14621, USA
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Fassihi SC, Gu A, Perim DA, Wei C, Stake S, Thakkar S, Unger AS, Ast MP, Sculco PK. Chronic preoperative corticosteroid use is not associated with surgical site infection following revision total knee arthroplasty. J Orthop 2020; 20:173-176. [PMID: 32025143 PMCID: PMC6997114 DOI: 10.1016/j.jor.2020.01.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/25/2020] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION The objective of this study was to determine whether chronic preoperative corticosteroid use is associated with increased infectious complications following revision total knee arthroplasty (rTKA). METHODS A retrospective cohort analysis was conducted using patients from a large national database. Patients were divided into two cohorts based upon chronic steroid usage preoperatively. Infectious complications in the 30-day postoperative period were recorded, and univariate and multivariate analyses were performed. RESULTS A total of 10,973 patients were included in this study. No significant difference was observed in surgical site infection rates between patients with and without preoperative steroid use. In multivariate analysis, preoperative steroid use was independently associated with an increased likelihood of septic shock (OR 6.17; p = 0.015) and prolonged length-of-stay (OR 1.57; p = 0.038). CONCLUSION Chronic preoperative steroid is not a significant risk factor for surgical site infection following rTKA, but it is independently associated with increased risk of septic shock and prolonged hospital length of stay.
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Affiliation(s)
- Safa C. Fassihi
- Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, 2300 Eye St NW, Washington DC, 20037, USA
| | - Alex Gu
- Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, 2300 Eye St NW, Washington DC, 20037, USA
- Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York City, NY, 10021, USA
| | - Dana A. Perim
- Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, 2300 Eye St NW, Washington DC, 20037, USA
| | - Chapman Wei
- Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, 2300 Eye St NW, Washington DC, 20037, USA
| | - Seth Stake
- Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, 2300 Eye St NW, Washington DC, 20037, USA
| | - Savyasachi Thakkar
- Department of Orthopaedic Surgery, MedStar Georgetown Orthopaedic Institute at Washington Hospital Center, 110 Irving St NW, Washington DC, 20010, USA
| | - Anthony S. Unger
- Gildenhorn Institute of Bone and Joint Health, Sibley Memorial Hospital, 5255 Loughboro Road NW, Washington, DC, 20016, USA
| | - Michael P. Ast
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 E 70th St, New York City, NY, 10021, USA
| | - Peter K. Sculco
- Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York City, NY, 10021, USA
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Fassihi SC, Mortman R, Shalkevich J, Lee D, Stoll WT, Thakkar S. Total Hip Arthroplasty for the Sequelae of Femoral Neck Fractures in the Pediatric Patient. Arthroplast Today 2020; 6:296-304. [PMID: 32509942 PMCID: PMC7264979 DOI: 10.1016/j.artd.2020.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/10/2020] [Accepted: 04/15/2020] [Indexed: 11/26/2022] Open
Abstract
Although rare, total hip arthroplasty (THA) may be indicated in pediatric patients with degenerative changes of the hip joint after previous trauma. To illustrate management principles in this patient population, this study describes the case of a 15-year-old female who sustained bilateral femoral neck fractures after a generalized tonic-clonic seizure, an atypical, low-energy mechanism for this injury. These fractures were not diagnosed until 14 weeks after the seizure episode, at which point they had progressed to nonunion on the left side, malunion on the right side, and degenerative hip joint changes were developing bilaterally. Bilateral THA was ultimately performed, and the patient had favorable outcomes at 1 year postoperatively. In determining the optimal management strategy for such patients, a multidisciplinary approach should be used, with input from the patient’s family, pediatrician, pediatric endocrinologist, pediatric orthopaedic surgeon, and adult reconstruction surgeon. From a surgical standpoint, this report highlights the importance of selecting the appropriate bearing surfaces, broaching technique, mode of implant fixation, and implant features when performing THA in the active pediatric patient.
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Affiliation(s)
- Safa C Fassihi
- Department of Orthopaedic Surgery, George Washington University, Washington, DC, USA
| | - Ryan Mortman
- Department of Orthopaedic Surgery, George Washington University, Washington, DC, USA
| | - Jacob Shalkevich
- Department of Orthopaedic Surgery, George Washington University, Washington, DC, USA
| | - Danny Lee
- Department of Orthopaedic Surgery, George Washington University, Washington, DC, USA
| | - William T Stoll
- Department of Orthopaedic Surgery, George Washington University, Washington, DC, USA
| | - Savyasachi Thakkar
- Department of Orthopaedic Surgery, Georgetown University MedStar Health, Washington, DC, USA
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Gu A, Chen FR, Chen AZ, Fassihi SC, Thakkar S, Unger AS, Liu J, Sculco PK, Ast MP. Preoperative hyponatremia is an independent risk factor for postoperative complications in aseptic revision hip and knee arthroplasty. J Orthop 2020; 20:224-227. [PMID: 32051674 DOI: 10.1016/j.jor.2020.01.028] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 01/24/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction The purpose of this study is to investigate the relationship between preoperative hyponatremia and postoperative complications in aseptic revision hip and knee arthroplasty. Methods Aseptic revision arthroplasties from 2007 to 2016 were collected using a large, United States database. Patients were stratified into eunatremic and hyponatremic cohorts. Rates of complications were collected and analyzed. Results 25,517 surgeries were evaluated. Preoperative hyponatremia was independently associated with organ/space infections (OR= 2.316; p<0.001), postoperative blood transfusions (OR= 1.467; p<0.001), pneumonia (OR= 2.05; p =0.002), sepsis (OR= 2.533; p<0.001), extended length-of-stay (OR= 2.221; p<0.001), minor complications (OR= 1.549; p<0.001), wound complications (OR= 1.505; p=0.001), pulmonary complications (OR= 1.72; p=0.007), and sepsis complications (OR= 2.305; p<0.001). Conclusion Hyponatremia is an independent risk factor for several postoperative complications in aseptic revision hip and knee arthroplasty.
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Affiliation(s)
- Alex Gu
- Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th, St, New York, NY, 10021, USA.,The George Washington University School of Medicine, Department of Orthopaedic Surgery, 2300 I St NW, Washington, DC, 20052, USA
| | - Frank R Chen
- Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA
| | - Aaron Z Chen
- Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA
| | - Safa C Fassihi
- The George Washington University School of Medicine, Department of Orthopaedic Surgery, 2300 I St NW, Washington, DC, 20052, USA
| | - Savyasachi Thakkar
- Department of Orthopaedic Surgery, MedStar Georgetown Orthopaedic Institute at Washington Hospital Center, 110 Irving St NW, Washington, DC, 20010, USA
| | - Anthony S Unger
- Gildenhorn Institute of Bone and Joint Health, Sibley Memorial Hospital, 5255 Loughboro Road NW, Washington, DC, 20016, USA
| | - Jiabin Liu
- Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th St, New York, NY, 10021, USA
| | - Peter K Sculco
- Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th, St, New York, NY, 10021, USA
| | - Michael P Ast
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th, St, New York, NY, 10021, USA
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Abel S, Schiffman S, Monga D, Finley G, Williams H, Thakkar S, Kirichenko A, Wegner R. Neoadjuvant Stereotactic Body Radiotherapy in Addition to Chemotherapy and Its Effect on Outcome in Resected Pancreatic Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Smith MS, Cash B, Konda V, Trindade AJ, Gordon S, DeMeester S, Joshi V, Diehl D, Ganguly E, Mashimo H, Singh S, Jobe B, McKinley M, Wallace M, Komatsu Y, Thakkar S, Schnoll-Sussman F, Sharaiha R, Kahaleh M, Tarnasky P, Wolfsen H, Hawes R, Lipham J, Khara H, Pleskow D, Navaneethan U, Kedia P, Hasan M, Sethi A, Samarasena J, Siddiqui UD, Gress F, Rodriguez R, Lee C, Gonda T, Waxman I, Hyder S, Poneros J, Sharzehi K, Di Palma JA, Sejpal DV, Oh D, Hagen J, Rothstein R, Sawhney M, Berzin T, Malik Z, Chang K. Volumetric laser endomicroscopy and its application to Barrett's esophagus: results from a 1,000 patient registry. Dis Esophagus 2019; 32:5481776. [PMID: 31037293 PMCID: PMC6853704 DOI: 10.1093/dote/doz029] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/08/2019] [Indexed: 12/11/2022]
Abstract
Volumetric laser endomicroscopy (VLE) uses optical coherence tomography (OCT) for real-time, microscopic cross-sectional imaging. A US-based multi-center registry was constructed to prospectively collect data on patients undergoing upper endoscopy during which a VLE scan was performed. The objective of this registry was to determine usage patterns of VLE in clinical practice and to estimate quantitative and qualitative performance metrics as they are applied to Barrett's esophagus (BE) management. All procedures utilized the NvisionVLE Imaging System (NinePoint Medical, Bedford, MA) which was used by investigators to identify the tissue types present, along with focal areas of concern. Following the VLE procedure, investigators were asked to answer six key questions regarding how VLE impacted each case. Statistical analyses including neoplasia diagnostic yield improvement using VLE was performed. One thousand patients were enrolled across 18 US trial sites from August 2014 through April 2016. In patients with previously diagnosed or suspected BE (894/1000), investigators used VLE and identified areas of concern not seen on white light endoscopy (WLE) in 59% of the procedures. VLE imaging also guided tissue acquisition and treatment in 71% and 54% of procedures, respectively. VLE as an adjunct modality improved the neoplasia diagnostic yield by 55% beyond the standard of care practice. In patients with no prior history of therapy, and without visual findings from other technologies, VLE-guided tissue acquisition increased neoplasia detection over random biopsies by 700%. Registry investigators reported that VLE improved the BE management process when used as an adjunct tissue acquisition and treatment guidance tool. The ability of VLE to image large segments of the esophagus with microscopic cross-sectional detail may provide additional benefits including higher yield biopsies and more efficient tissue acquisition. Clinicaltrials.gov NCT02215291.
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Affiliation(s)
- M S Smith
- Mount Sinai West & Mount Sinai St. Luke's Hospitals, New York, New York,Address correspondence to: Michael S. Smith, M.D., M.B.A., Chief of Gastroenterology and Hepatology, Mount Sinai West & Mount Sinai St. Luke's Hospitals, Ambulatory Care Center, Floor 13, 440 W. 114th Street, New York, NY 10025, USA.
| | - B Cash
- University of Texas Health Science Center at Houston, Houston, Texas
| | - V Konda
- Baylor University Medical Center, Dallas, Texas
| | - A J Trindade
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health System Manhasset, New York
| | - S Gordon
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - V Joshi
- University Medical Center at LSU, New Orleans, Louisiana
| | - D Diehl
- Geisinger Medical Center, Danville, Pennsylvania
| | - E Ganguly
- University of Vermont Medical Center, Burlington, Vermont
| | - H Mashimo
- VA Boston Health Care System, Boston, Massachusetts
| | - S Singh
- VA Boston Health Care System, Boston, Massachusetts
| | - B Jobe
- Allegheny Health Network, Pittsburgh, Pennsylvania
| | - M McKinley
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health System Manhasset, New York,ProHEALTHcare Associates, Lake Success, New York, New York
| | | | - Y Komatsu
- Allegheny Health Network, Pittsburgh, Pennsylvania
| | - S Thakkar
- Allegheny Health Network, Pittsburgh, Pennsylvania
| | | | - R Sharaiha
- Weill Cornell Medicine, New York, New York
| | - M Kahaleh
- Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | | | | | - R Hawes
- Florida Hospital, Orlando, Florida
| | - J Lipham
- University of Southern California, Keck School of Medicine, Los Angeles, California
| | - H Khara
- Geisinger Medical Center, Danville, Pennsylvania
| | - D Pleskow
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - P Kedia
- Methodist Health System, Dallas, Texas
| | - M Hasan
- Florida Hospital, Orlando, Florida
| | - A Sethi
- Columbia University Medical Center, New York, New York
| | | | | | - F Gress
- Columbia University Medical Center, New York, New York
| | - R Rodriguez
- University of South Alabama, Mobile, Alabama
| | - C Lee
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health System Manhasset, New York
| | - T Gonda
- Columbia University Medical Center, New York, New York
| | - I Waxman
- Chicago Medicine, Chicago, Illinois
| | - S Hyder
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - J Poneros
- Columbia University Medical Center, New York, New York
| | - K Sharzehi
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - J A Di Palma
- University of Texas Health Science Center at Houston, Houston, Texas
| | - D V Sejpal
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health System Manhasset, New York
| | - D Oh
- University of Southern California, Keck School of Medicine, Los Angeles, California
| | - J Hagen
- University of Southern California, Keck School of Medicine, Los Angeles, California
| | - R Rothstein
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - M Sawhney
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - T Berzin
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Z Malik
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - K Chang
- UC Irvine Medical Center, Irvine, California
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Aggarwal V, Thakkar S, Collins K, Vigdorchik J. Same Day Discharge After Total Joint Arthroplasty The Future May Be Now. Bull Hosp Jt Dis (2013) 2017; 75:252-256. [PMID: 29151010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Total joint arthroplasty has traditionally been performed as an inpatient procedure to mitigate the risks of perioperative complications, limited mobility, and pain control issues. Reducing readmissions and complications is increasingly important with the push toward outcomes based reimbursement. Nonetheless, there is a definite trend toward not only shortening postoperative length of stay but also toward considering a same day discharge arthroplasty model in appropriately selected patients. In this review, we outline the literature evidence regarding same day discharge in total joint arthroplasty and discuss our own institutional guidelines for appropriate patient selection as well as contraindications.
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Osmani FA, Thakkar S, Ramme A, Elbuluk A, Wojack P, Vigdorchik JM. Variance in predicted cup size by 2-dimensional vs 3-dimensional computerized tomography-based templating in primary total hip arthroplasty. Arthroplast Today 2017; 3:289-293. [PMID: 29204499 PMCID: PMC5712012 DOI: 10.1016/j.artd.2016.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 08/28/2016] [Accepted: 09/01/2016] [Indexed: 11/29/2022] Open
Abstract
Background Preoperative total hip arthroplasty templating can be performed with radiographs using acetate prints, digital viewing software, or with computed tomography (CT) images. Our hypothesis is that 3D templating is more precise and accurate with cup size prediction as compared to 2D templating with acetate prints and digital templating software. Methods Data collected from 45 patients undergoing robotic-assisted total hip arthroplasty compared cup sizes templated on acetate prints and OrthoView software to MAKOplasty software that uses CT scan. Kappa analysis determined strength of agreement between each templating modality and the final size used. t tests compared mean cup-size variance from the final size for each templating technique. Interclass correlation coefficient (ICC) determined reliability of digital and acetate planning by comparing predictions of the operating surgeon and a blinded adult reconstructive fellow. Results The Kappa values for CT-guided, digital, and acetate templating with the final size was 0.974, 0.233, and 0.262, respectively. Both digital and acetate templating significantly overpredicted cup size, compared to CT-guided methods (P < .001). There was no significant difference between digital and acetate templating (P = .117). Interclass correlation coefficient value for digital and acetate templating was 0.928 and 0.931, respectively. Conclusions CT-guided planning more accurately predicts hip implant cup size when compared to the significant overpredictions of digital and acetate templating. CT-guided templating may also lead to better outcomes due to bone stock preservation from a smaller and more accurate cup size predicted than that of digital and acetate predictions.
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Affiliation(s)
- Feroz A Osmani
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Disease, New York, NY, USA
| | - Savyasachi Thakkar
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Disease, New York, NY, USA
| | - Austin Ramme
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Disease, New York, NY, USA
| | - Ameer Elbuluk
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Disease, New York, NY, USA
| | - Paul Wojack
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Disease, New York, NY, USA
| | - Jonathan M Vigdorchik
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Disease, New York, NY, USA
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Osmani F, Thakkar S, Vigdorchik J. The Utility of Conservative Treatment Modalities in the Management of Osteonecrosis. Bull Hosp Jt Dis (2013) 2017; 75:186-192. [PMID: 28902603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Osteonecrosis is an ischemic pathologic process associated with a number of conditions affecting a range of age groups. The problem faced in the management of osteonecrosis is whether conservative treatment is a viable and effective option for patients. In this systematic review, we investigated the efficacy of various nonoperative treatment modalities for hip and knee osteonecrosis, including pharmacological management and biophysical modalities. METHODS We identified 16 studies based on electronic searches through the PubMed, Embase, CINAHL Plus, and Cochrane databases from January 2001 to November 2015. The therapies we assessed for the conservative osteonecrosis management included bisphosphonates, prostaglandin agents, enoxaparin, statins, hyperbaric oxygen, extracorporeal shockwave therapy, and pulsed electromagnetic field therapy. RESULTS Several studies have reported that early intervention (Fiscat stage I/II) osteonecrosis can be effectively managed conservatively. Pain levels and rate of bone necrosis was decreased with bisphosphonate use. Iloprost was seen to have improvement in pain, functional, and radiological outcomes. Progression of osteonecrosis was curbed with enoxaparin use. Statin use was seen to have protective effects on bone in patients taking high dose corticosteroids. The biophysical modalities (hyperbaric oxygen, extracorporeal shockwave therapy, and pulsed electromagnetic field therapy) all saw delay and partial reversal of disease progression. CONCLUSION Generally, stage I and II, prior to subchondral collapse, can be approached with both pharmacological and biophysical treatment modalities before more invasive measures, such as core decompression, are considered. At stage III and beyond, these conservative treatments are no longer viable treatment options. Further research must be performed to determine which modality carries the best cost to risk to benefit ratio in order to establish a standard of care for the treatment of osteonecrosis.
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Yang C, Thakkar S, Mostrag A, Gombar V, Bienfait B, Rathman J, Tong W. In silico assessment of drug-induced liver injury in humans. Toxicol Lett 2016. [DOI: 10.1016/j.toxlet.2016.06.1480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
BACKGROUND The sliding screw-plate devices and cephalo-medullary nail devices have performed well in stable inter-trochanteric fractures in patients with reasonably good quality of bone. However, their suboptimal performance in comminuted fractures in the presence of osteoporotic bone has prompted many surgeons to consider bipolar hemiarthroplasty as the primary modality of management of comminuted inter-trochanteric fractures in elderly patients. However, long term stability of the hemiarthroplasty implant also may be compromised due to the presence of postero-medial bone loss at the area of the calcar. MATERIALS AND METHODS We have presented a simple and effective technique of calcar grafting by harvesting cortical bone strut from the neck of the fractured femur. A total of 34 patients with inter-trochanteric fractures of the femur were treated with calcar grafting. The mean age was 79.2 years. The graft was harvested from the calcar region of the head and neck fragment of the femur and wedged between the medial femoral cortex and medial edge of the prosthesis. The mean followup period was 54.5 months. RESULTS In 32 of 34 (94%) patients in our series, the calcar graft healed well without dislodgement. There was graft resorption in two patients associated with subsidence of the implant and loosening. CONCLUSION Calcar grafting using this technique provides stability to the implant in the presence of comminution and incorporates well in the majority of patients. Donor site morbidity of graft harvesting is also avoided.
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Affiliation(s)
| | | | | | - Malhar N Kumar
- Department of Orthopaedics, HOSMAT Hospital, Bengaluru, Karnataka, India
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Cruz-Hernandez C, Roessle C, Thakkar S, Masserey-Elmelegy I, Coulet M, Sauret W, Grathwohl D, Wynn E, Goulet L, Destaillats F, Giuffrida F, Giusti V. PP077-SUN: Comparison of the Efficacy of Mag and Tag to Deliver LC-PUFA under Malabsorption Conditions. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50119-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Packard M, Kirichenko A, Gayou O, Weiss B, Thakkar S, Werts ED. Use of Implanted Gold Fiducial Markers With MV-CBCT Image Guided IMRT for Pancreatic Tumors. Pract Radiat Oncol 2013; 3:S14-5. [PMID: 24674491 DOI: 10.1016/j.prro.2013.01.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- M Packard
- Allegheny General Hospital, Pittsburgh, PA
| | | | - O Gayou
- Allegheny General Hospital, Pittsburgh, PA
| | - B Weiss
- Allegheny General Hospital, Pittsburgh, PA
| | - S Thakkar
- Allegheny General Hospital, Pittsburgh, PA
| | - E D Werts
- Allegheny General Hospital, Pittsburgh, PA
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Smith SD, Bolwell BJ, Rybicki LA, Kang T, Dean R, Advani A, Thakkar S, Sobecks R, Kalaycio M, Pohlman B, Sweetenham JW. Comparison of outcomes after auto-SCT for patients with relapsed diffuse large B-cell lymphoma according to previous therapy with rituximab. Bone Marrow Transplant 2010; 46:262-6. [DOI: 10.1038/bmt.2010.95] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Thakkar S, Hutson T, Garcia J, Rothaermal J, Bart M, Dreicer R. A phase II trial of gemcitabine and docetaxel in hormone-refractory metastatic prostate cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.14501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] Open
Abstract
14501 Background: Docetaxel is a microtubule stabilizing agent with demonstrated ability to improve survival in patients (pts) with hormone refractory metastatic prostate cancer (HRMPC). Gemcitabine is a nucleoside analogue that exhibits broad antitumor activity, although as a single agent has modest activity in advanced prostate cancer. The combination of docetaxel and gemcitabine has demonstrated significant activity in a variety of chemotherapy resistant neoplasms. We performed a phase II study of this combination to assess its safety and antitumor activity in chemotherapy naïve patients with HRMPC. Methods: Eligible pts had HRMPC with radiologic and/or biochemical evidence of progression following antiandrogen withdrawal with castrate testosterone levels, ECOG PS 0–2 and adequate organ function; no prior chemotherapy was permitted. Gemcitabine (800 mg/m2) was administered on days 1 and 8 and docetaxel (75mg/m2) on day 8 every 21 days for a maximum of 6 cycles. Results: Twenty-nine pts have been enrolled to date with 22 currently evaluable for response, all are evaluable for toxicity. The median age was 68. The average number of cycles completed was 4.9. Nine pts have experienced grade 4 neutropenia (1 neutropenic fever admission). Twelve of 29 pts have required dose delays secondary to wbc or platelets, two pts have required dose modification. Non-hematologic grade 3/4 toxicities include 1 pt with a PE, 1 grade 4 dyspnea, 1 grade 4 GI bleed. Four pts (18%) achieved measurable disease + PSA, partial response (PR), 7 (32%) additional pts had >50% decline in PSA, for a composite overall response rate of 50%. Conclusions: The combination of gemcitabine and docetaxel is moderately toxic primarily impacting bone marrow reserve. Although there is evidence of significant antitumor activity, the ulitmiate utility of this doublet remains undefined. Accrual to this study is ongoing. [Table: see text]
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Affiliation(s)
- S. Thakkar
- Cleveland Clinic, Cleveland, OH; Baylor Sammons Cancer Center/Texas Oncology, PA, Dallas, TX
| | - T. Hutson
- Cleveland Clinic, Cleveland, OH; Baylor Sammons Cancer Center/Texas Oncology, PA, Dallas, TX
| | - J. Garcia
- Cleveland Clinic, Cleveland, OH; Baylor Sammons Cancer Center/Texas Oncology, PA, Dallas, TX
| | - J. Rothaermal
- Cleveland Clinic, Cleveland, OH; Baylor Sammons Cancer Center/Texas Oncology, PA, Dallas, TX
| | - M. Bart
- Cleveland Clinic, Cleveland, OH; Baylor Sammons Cancer Center/Texas Oncology, PA, Dallas, TX
| | - R. Dreicer
- Cleveland Clinic, Cleveland, OH; Baylor Sammons Cancer Center/Texas Oncology, PA, Dallas, TX
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Thakkar S, Manes M. Adsorptive displacement analysis of many-component priority pollutants on activated carbon. Environ Sci Technol 1987; 21:546-549. [PMID: 19994973 DOI: 10.1021/es00160a003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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