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Giri A, Freeman TH, Kim P, Kuhn JE, Garriga GA, Khazzam M, Higgins LD, Matzkin E, Baumgarten KM, Bishop JY, Brophy RH, Carey JL, Dunn WR, Jones GL, Ma CB, Marx RG, McCarty EC, Poddar SK, Smith MV, Spencer EE, Vidal AF, Wolf BR, Wright RW, Jain NB. Obesity and sex influence fatty infiltration of the rotator cuff: the Rotator Cuff Outcomes Workgroup (ROW) and Multicenter Orthopaedic Outcomes Network (MOON) cohorts. J Shoulder Elbow Surg 2022; 31:726-735. [PMID: 35032677 PMCID: PMC8940702 DOI: 10.1016/j.jse.2021.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/09/2021] [Accepted: 12/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fatty infiltration (FI) is one of the most important prognostic factors for outcomes after rotator cuff surgery. Established risk factors include advancing age, larger tear size, and increased tear chronicity. A growing body of evidence suggests that sex and obesity are associated with FI; however, data are limited. METHODS We recruited 2 well-characterized multicenter cohorts of patients with rotator cuff tears (Multicenter Orthopaedic Outcomes Network [MOON] cohort [n = 80] and Rotator Cuff Outcomes Workgroup [ROW] cohort [n = 158]). We used multivariable logistic regression to evaluate the relationship between body mass index (BMI) and the presence of FI while adjusting for the participant's age at magnetic resonance imaging, sex, and duration of shoulder symptoms, as well as the cross-sectional area of the tear. We analyzed the 2 cohorts separately and performed a meta-analysis to combine estimates. RESULTS A total of 27 patients (33.8%) in the Multicenter Orthopaedic Outcomes Network (MOON) cohort and 57 patients (36.1%) in the Rotator Cuff Outcomes Workgroup (ROW) cohort had FI. When BMI < 25 kg/m2 was used as the reference category, being overweight was associated with a 2.37-fold (95% confidence interval [CI], 0.77-7.29) increased odds of FI and being obese was associated with a 3.28-fold (95% CI, 1.16-9.25) increased odds of FI. Women were 4.9 times (95% CI, 2.06-11.69) as likely to have FI as men. CONCLUSIONS Among patients with rotator cuff tears, obese patients had a substantially higher likelihood of FI. Further research is needed to assess whether modifying BMI can alter FI in patients with rotator cuff tears. This may have significant clinical implications for presurgical surgical management of rotator cuff tears. Sex was also significantly associated with FI, with women having higher odds of FI than men. Higher odds of FI in female patients may also explain previously reported early suboptimal outcomes of rotator cuff surgery and higher pain levels in female patients as compared with male patients.
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Affiliation(s)
- Ayush Giri
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Thomas H Freeman
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter Kim
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John E Kuhn
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gustavo A Garriga
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Khazzam
- Department of Orthopaedics, University of Texas Southwestern, Dallas, TX, USA
| | | | - Elizabeth Matzkin
- Department of Orthopaedic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Julie Y Bishop
- Departments of Orthopaedic Surgery and Sports Medicine, Ohio State University, Columbus, OH, USA
| | - Robert H Brophy
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - James L Carey
- Department of Orthopaedic Surgery, University of Pennsylvania and Perelman School of Medicine, Philadelphia, PA, USA
| | - Warren R Dunn
- Department of Clinical Research, Fondren Orthopedic Group, Houston, TX, USA
| | - Grant L Jones
- Departments of Orthopaedic Surgery and Sports Medicine, Ohio State University, Columbus, OH, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Robert G Marx
- Department of Orthopedic Surgery, Weill Medical College of Cornell University, New York, NY, USA
| | - Eric C McCarty
- Department of Orthopedic Sports Medicine, University of Colorado, Denver, CO, USA
| | - Sourav K Poddar
- Department of Orthopedic Sports Medicine, University of Colorado, Denver, CO, USA
| | - Matthew V Smith
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Edwin E Spencer
- Shoulder & Elbow Division, Knoxville Orthopaedic Clinic, Knoxville, TN, USA
| | - Armando F Vidal
- The Steadman Clinic and Steadman Philippon Research Institute, Vial, CO, USA
| | - Brian R Wolf
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Rick W Wright
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nitin B Jain
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA; Departments of Physical Medicine and Rehabilitation, Orthopaedics, and Population & Data Sciences, University of Texas Southwestern, Dallas, TX, USA.
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Bowman EN, Freeman TH, Limpisvasti O, Cole BJ, ElAttrache NS. Anterior cruciate ligament reconstruction femoral tunnel drilling preference among orthopaedic surgeons. Knee 2021; 29:564-570. [PMID: 33774590 DOI: 10.1016/j.knee.2021.02.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 01/13/2021] [Accepted: 02/22/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Anterior cruciate ligament reconstruction (ACLR) technique for femoral tunnel drilling varies substantially, each with advantages and disadvantages. The purpose of this study was to define ACLR femoral tunnel technique predilection among surgeons and to explore factors associated with their preference. METHODS An 11-question survey regarding ACLR femoral tunnel technique was completed by 560 AANA/AOSSM members. Surgeon and practice demographics and residency and fellowship experiences were evaluated with bivariate and multivariable models for association with surgeon preference. RESULTS In current practice, 55% of surgeons prefer anteromedial (AM) portal drilling, 32% retrograde, and 14% transtibial (TT). Sports Medicine fellowship experience was the strongest predictor of current practice (p < 0.001), followed by residency technique (p = 0.014). A significant increase in TT drilling was noted for those practicing >15 years TT (29% vs 3%, p < 0.001), with an inverse relationship for retrograde drilling (38% vs 21%, p < 0.001). Number of ACLRs/year and percent Sports specific practice were significant predictors for AM drilling (p < 0.001). Though less than AM and retrograde, TT was more common for those in private practice (17% vs 8%, p < 0.001), and more prevalent in the Midwest/Southeast (19% vs 10%, p = 0.003). Non-significant predictors included highest level of athlete for whom an ACLR had been performed, level of athlete serving as team physician, and Certificate of Added Qualifications status. CONCLUSION Surgeon training, practice setting, and years in practice significantly predict preference for femoral tunnel drilling technique. Surgeon comfort and confidence in attaining an anatomic reconstruction should drive choice of technique.
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Affiliation(s)
- Eric N Bowman
- Department of Orthopaedics, Vanderbilt University Medical Center, 1215 21st Avenue South, 4200 Medical Center East, Nashville, TN 37232-8774, United States.
| | - Thomas H Freeman
- Department of Orthopaedics, Vanderbilt University Medical Center, 1215 21st Avenue South, 4200 Medical Center East, Nashville, TN 37232-8774, United States.
| | - Orr Limpisvasti
- Attending Orthopaedic Surgeon, Kerlan Jobe Institute, 6801 Park Terrace, Los Angeles, CA 90045, United States
| | - Brian J Cole
- Department of Orthopaedics, Rush University Medical Center, 1611 W Harrison, Suite 300, Chicago, IL 60612, United States.
| | - Neal S ElAttrache
- Attending Orthopaedic Surgeon, Kerlan Jobe Institute, 6801 Park Terrace, Los Angeles, CA 90045, United States.
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Wilson RJ, Freeman TH, Halpern JL, Schwartz HS, Holt GE. Surgical Outcomes After Limb-Sparing Resection and Reconstruction for Pelvic Sarcoma: A Systematic Review. JBJS Rev 2019; 6:e10. [PMID: 29688908 DOI: 10.2106/jbjs.rvw.17.00072] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Limb-sparing resection and reconstruction for pelvic sarcomas in multiple small studies have been fraught with complications, reoperations, and impaired patient function. However, the non-oncologic complication and reoperation rates and functional outcomes for patients have never been rigorously compiled, to our knowledge. A systematic review was undertaken to more accurately determine the non-oncologic complication and reoperation rates and functional outcomes for patients after pelvic sarcoma resection and reconstruction. METHODS The review was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed and Cochrane database searches of English-only studies using the terms "pelvis AND sarcoma" and "pelvis AND sarcoma AND surgery" were performed. Study inclusion criteria were ≥10 patients enrolled, at least 12 months of follow-up, utilization of comparable functional outcome measure(s), and the majority of the resections treating primary bone sarcoma. RESULTS In this study, 2,350 studies were reviewed, of which 22 Level-IV studies with a total of 801 patients met inclusion criteria. Reconstructive techniques varied widely and included allografts, allograft-prosthesis composites, saddle prostheses, custom endoprostheses, and irradiated autografts. Pooled means showed a mean 5-year patient survival of 55%. The mean non-oncologic complication rate was 49%. The mean non-oncologic reoperation rate was 37%. The mean Musculoskeletal Tumor Society score was 65%. CONCLUSIONS The non-oncologic complication and reoperation rates for pelvic reconstructions are remarkably high and 5-year survival is poor. Functional outcomes are acceptable but may not be better than a resection of the same Enneking and Dunham type without reconstruction. Consideration should be given to forgoing pelvic reconstruction, especially in patients with poor overall prognosis. Further studies comparing non-oncologic complication rates, reoperation rates, and functional outcomes in patients with equivalent resections treated with or without reconstruction are needed to further elucidate the utility of pelvic reconstruction. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Robert J Wilson
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas H Freeman
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jennifer L Halpern
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Herbert S Schwartz
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ginger E Holt
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
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Vasquez RA, Chotai S, Freeman TH, Kay HF, Cheng JS, McGirt MJ, Devin CJ. Impact of Discharge Disposition on 30-Day Readmissions Following Elective Spine Surgery. Neurosurgery 2017; 81:772-778. [PMID: 28605552 DOI: 10.1093/neuros/nyx114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 05/31/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Readmissions are a significant economic burden on the health care system and increasingly being utilized as a metric of quality. Patients discharged to home vs an inpatient facility have different characteristics, which might influence the readmissions following spine surgery. OBJECTIVE To determine the effect of discharge disposition on readmission rates and causes of readmission after spine surgery. METHODS Patients enrolled in a prospective registry and undergoing elective spine surgery were analyzed. Readmissions (30 d), demographic, clinical variables, and baseline patient-reported outcomes were recorded. Patients were dichotomized as discharged home vs inpatient facility. RESULTS Of total 1631 patients, 1444 (89%) patients were discharged home and 187 (11%) discharged to an inpatient facility. Sixty-five (4%) patients were readmitted at 30 d. There was no significant difference in readmissions between patients discharged to a facility 10 (5%) vs home 55 (4%; P = .210). In a multivariable analysis, adjusting for all the comorbidities, the discharge destination was not associated with readmission within 30 d. The medical complications (80%) were the most common cause of readmission in those discharged to a facility. Patients discharged home had significantly higher readmissions related to surgical wound issues (67%; P = .034). CONCLUSION Despite the older age and higher comorbidities in patients discharged to an inpatient facility, the proportion of readmissions was comparable to those discharged home. Patients discharged home had a higher proportion of readmissions related to surgical wound complications and those discharged to facility had higher readmissions associated with medical complications. Understanding causes of readmission based on discharge destination may allow targeted intervention to reduce the readmission rates following spine surgery.
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Affiliation(s)
- Raul A Vasquez
- Department of Neurosurgery, University of Kentucky, Lexington, Kentucky
| | - Silky Chotai
- Department of Orthopedics and Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Thomas H Freeman
- Department of Orthopedics and Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Harrison F Kay
- Department of Orthopedics and Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph S Cheng
- Department of Neurosurgery, Yale University, New Haven, Connecticut
| | - Matthew J McGirt
- Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | - Clinton J Devin
- Department of Orthopedics and Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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