Abstract Readmission has been cited as an important quality measure in the Patient Protection and Affordable Care Act. We queried an electronic database for all patients who underwent Total Hip ...Arthroplasty or Total Knee Arthroplasty at our institution from 2006 to 2010 and identified those readmitted within 90 days of surgery, reviewed their demographic and clinical data, and performed a multivariable logistic regression analysis to determine significant risk factors. The overall 90-day readmission rate was 7.8%. The most common readmission diagnoses were related to infection and procedure-related complications. An increased likelihood of readmission was found with coronary artery disease, diabetes, increased LOS, underweight status, obese status, age (over 80 or under 50), and Medicare. Procedure-related complications and wound complications accounted for more readmissions than any single medical complication.
Abstract Jones fractures are reportedly prone to nonunion and generally treated with a period of non-weightbearing or operative treatment. Extended non-weightbearing can have adverse effects, and ...operative treatment poses various risks. We report the clinical results of patients treated without weightbearing restriction. All patients treated for metatarsal fractures by a single surgeon from January 1, 2000 to December 31, 2009 were identified through the clinical billing records by International Classification of Diseases, ninth revision, code. Through a radiographic and medical record review, 27 consecutive patients with acute Jones fractures treated without weightbearing restriction were identified. The demographic information and clinical and radiographic results were recorded. Of the 27 patients, 24 (89%) had achieved clinical union at a mean of 8.0 ± 2.6 weeks. Complete radiographic union was noted in 13 (48%) patients, and 13 (48%) others had made significant progress toward radiographic union but had not yet reached it. Two (8.3%) patients were lost to follow-up. One patient (4%) developed nonunion. Patients with acute Jones fractures can be treated without weightbearing restriction. This protocol results in rapid clinical union and a low rate of nonunion.
Abstract Readmission rates have been cited as an important quality measure in the Affordable Care Act. Accordingly, understanding and accurately tracking the causes for readmission will be ...increasingly important. We queried an electronic database for all patients who underwent primary THA or TKA at our institution from 2006 through 2010. We identified those readmitted within 90 days of surgery and analyzed 87 random de-identified medical records. We then assigned a clinical diagnosis for each readmission, which was then compared with the coder-derived diagnosis by ICD-9 code. The overall 90-day readmission rate was 7.9%. We identified 22 of 87 patients for whom there was disagreement (25.3%, 95% CI = 16.6–35.8%). The most common were procedure-related complications. Coded diagnoses frequently did not correlate with the physician-derived diagnoses. The unverified use of coded readmission diagnoses in calculating quality measures may not be clinically relevant.
Background Infection after shoulder surgery can have devastating consequences. Recent literature has implicated Propionibacterium acnes as a causative agent for postoperative shoulder infections. ...Axillary hair removal has been suggested as a method for infection prevention, although data quantifying its effect on the bacterial load around the shoulder are lacking. Methods We clipped one randomly selected axilla in 85 healthy male volunteers with commercially available surgical clippers. Aerobic and anaerobic culture specimens were taken from the clipped and unclipped axillae. Each shoulder was then prepared with 2% chlorhexidine gluconate and 70% isopropyl alcohol. Repeated culture specimens were then taken from both axillae. Cultures were held for 14 days and recorded with a semiquantitative system (0-4 points). Results were compared by the Wilcoxon signed rank test. Results There was no difference in the burden of P. acnes between the clipped and unclipped axillae before or after surgical preparation ( P = .109, P = .344, respectively). There was a significantly greater bacterial burden in the clipped shoulder compared with the unclipped shoulder before preparation ( P < .001) but not after preparation ( P = .285). There was a significant reduction in total bacterial load and P. acnes load for both axillae after surgical preparation ( P < .001 for all). Conclusions Removal of axillary hair has no effect on the burden of P. acnes in the axilla. Clipped axillae had a higher total bacterial burden. A 2% chlorhexidine gluconate surgical preparation is effective at removal of all bacteria and specifically P. acnes from the axilla.
Abstract Background: The classification of fractures is necessary to ensure a reliable means of communication for clinical interaction, education and research. The Neer classification is the most ...commonly used classification for proximal humerus fractures. In 2018 the Orthopedic Trauma Association (OTA) and the AO Foundation provided an update to the OTA/AO Fracture Classification Scheme addressing many of the concerns about the previous versions of the classification. The objective of the present study was to evaluate the rater reliability of the 2 classifications and if the classifications subjectively better characterized the fracture patterns. Methods: X-rays and CT scans of 24 proximal humerus fractures were given to 7 independent raters for classification according to the Neer and 2018 OTA/AO classification. Both full-forms and short-forms of the classifications were tested. The Fleiss Kappa statistic was used to assess inter-rater agreement and intra-rater consistency for the 2 classifications. For each case the raters subjectively commented on how well each classification was able to characterize the fracture pattern. Results: All raters graded the 2018 OTA/AO classification as good as or better than the Neer classification for an adequate description of the fracture patterns. The short-form 2018 OTA/AO classification had the most 4 rater and 5 rater agreement cases and the second most 6 rater agreement cases. The short-form Neer classification had the second most 4 rater and 5 rater agreement cases and the most 6 rater agreement cases. The full 2018 OTA/AO had the least 4, 5, or 6 rater agreement cases of all the classification systems. Inter-rater agreement was fair for the full and short form of both the Neer and 2018 OTA/AO classification. The full and short Neer classifications together with the short 2018 OTA/AO classification had moderate intra-rater consistency, while the full 2018 OTA/AO classification only had slight intra-rater consistency. Conclusions: The 2018 OTA/AO classification is equivalent in its short-form to the Neer classification in inter-rater reliability and intra-rater consistency; and is superior in its full form for characterizing specific fracture types. The low inter-rater reliability of the full 2018 OTA/AO classification is a concern that may need to be addressed in the future.
Category:
Ankle, Trauma, Mental Health
Introduction/Purpose:
Recognizing psychological risk factors for developing Complex Regional Pain Syndrome (CRPS) may facilitate the diagnosis of CRPS and can ...be critical in its prevention and treatment. The purpose of this study was to evaluate the association between psychological dysfunction and developing CRPS after sustaining an ankle fracture.
Methods:
The PearlDiver patient record database was used to identify patients who sustained an ankle fracture between 2005 and 2015. These patients were screened for development of CRPS based on the presence or absence of psychological disorders including anxiety disorder, bipolar disorder, delirium, psychosis, depression, chronic pain syndrome, and fibromyalgia. A substratification analysis was performed assessing the additional risk of developing CRPS by undergoing operative versus nonoperative management.
Results:
163,529 patients were identified who sustained an ankle fracture and CRPS was identified in 10,127 (6.2%) of these patients. The risk of developing CRPS after sustaining an ankle fracture was significantly elevated with an OR of 5.44 (P<0.001) in patients with a psychological disorder. The psychological disorders that were most predictive of developing CRPS included delirium (OR 5.60, P<0.001), bipolar disorder (OR 5.64, P<0.001), and anxiety disorder (OR 5.08, P<0.001) (Table I). The OR for developing CRPS in patients with a psychological disorder was 5.57 (P<0.001) for patients who received operative treatment and 5.30 (P<0.001) for patients who received closed treatment. There was no additional risk (OR 0.98, P= 0.31) for developing CRPS in patients with a psychological disorder who underwent operative management.
Conclusion:
Patients with a known psychological disorder were five times more likely to develop CRPS after sustaining an ankle fracture. There was no additional risk due to operative management. This information may be useful in the diagnosis and treatment of patients with mental health disorders who sustain an ankle fracture and subsequently develop CRPS.
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