A Systematic Approach to Perioperative Smoking Cessation
In this report, we outline evidence-based principles for perioperative smoking cessation and describe initial results from a perioperative smoking cessation program.
Results:
In the first 100 days of the Duke Perioperative Smoking Cessation Program, we received 420 referrals. Participants had a mean pack-year history of 50.3 (packs/day×years smoking; SD 32.5), a mean Fagerström Test for Nicotine Dependence score of 4.5 (SD 2.5), and a mean expired breath carbon monoxide of 11.8 (SD 7.5) parts per million. Mean days from initial perioperative smoking cessation visit to surgery was 21.4 (SD 22.3).
Discussion:
This mo...
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Symposium Source Type: research
Preoperative Optimization of Chronic Pain Patients Undergoing Surgery
Surgery presents unique challenges in pain management for patients with chronic pain. A perioperative optimization program, starting at decision to surgery, is likely to yield the best results for this population. Perioperative optimization focuses on psychological, medical, and physical optimization. Psychological optimization includes cognitive behavior therapy, relaxation, and music therapy. Medical optimization focuses on the multimodal approaches of pharmacological adjustment and physical optimization focuses on prehabilitation and nutrition optimization. The ideal care model incorporates these optimization strategies...
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Symposium Source Type: research
Perioperative Nutrition Care of Orthopedic Surgery Patient
Despite evidence that malnutrition is associated with significant complications in orthopedic surgery, unrecognized malnutrition continues to be a “silent epidemic,” affecting up to 50% of hospitalized patients. Specifically, presurgical malnutrition is associated with increased risk for surgical site infections, increased length of hospital stay, and increased health care costs in patients following total joint arthroplasty. Serologic markers (ie, serum albumin and total lymphocyte count), anthropometric measurements (ie, calf muscle circumference and triceps skinfold), and assessment and screening tools (ie, The Rain...
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Symposium Source Type: research
Preoperative Anemia Management: Value-based Care for Orthopedic Surgery
Preoperative anemia is common in elective orthopedic surgical patients and is an independent risk factor for perioperative morbidity and mortality. The detrimental effects of anemia on surgical outcomes impact the costs associated with perioperative care as well. In addition to the direct expenditures related to the complications of anemia, perioperative anemia is the leading predictor of perioperative transfusion and it is estimated that up to 6 million dollars are spent on transfusion-related costs per hospital per year. Anemia is a preventable and manageable condition that can often be treated effectively without relyin...
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Symposium Source Type: research
Overview: Value-based Care for Orthopedic Surgery
An overview of health care value definitions, the current health care paradigm and brief history of the origins of value-based care in orthopedics are presented. The 4 pillar strategic approach for achieving high-value musculoskeletal services includes (1) increasing revenue, (2) decreasing costs, (3) improving the patient experience, and (4) improving quality. The tactics for success in value-based orthopedic care are reviewed and discussed. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Symposium Source Type: research
Moving Toward Preoperative Optimization and Value-based Perioperative Care
No abstract available (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Preface Source Type: research
The Next Step to Improve the Quality of Techniques in Orthopaedics
No abstract available (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Editorial Source Type: research
A Simple Technical Tip for Removal of Intramedullary Broken Drill Bit
A 35-year-old man presented to us with nonunion of both bones of the right forearm. He was planned for open reduction and internal fixation. Intraoperatively while trying to open the medullary canal of the ulna with a 2.5-mm noncannulated drill bit, the distal end of the drill bit broke and was stuck within the medullary cavity. Under image intensifier, the broken piece was retrieved with the help of a long depth gauge from the 4.5-mm system. This technique is simple, cost-effective, and less time-consuming. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - November 15, 2019 Category: Orthopaedics Tags: Tips and Pearls Source Type: research
A Novel Technique to Remove Posterior Intra-Articular Bodies Within the Hip Through an Anterior Approach
We describe 2 cases of hip intra-articular foreign body removal through an anterior approach utilizing a Satinsky vascular clamp under fluoroscopic guidance. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - November 15, 2019 Category: Orthopaedics Tags: Tips and Pearls Source Type: research
External Distraction for Treatment of Rigid Sharp-angled Myelomeningocele-related Kyphosis With Skin Ulceration: Case Report
Objectives of our research: tо follow long-term results of staged surgical treatment of a patient with sharp-angled myelomeningocele-related rigid kyphosis, back skin scarring, and skin ulceration on top of gibbous; to assess efficiency and safety of using external distraction method as a preparatory stage for kyphectomy in such patients. Usage of external distraction with subsequent kyphectomy in patient with sharp-angled myelomeningocele-related kyphosis and skin ulceration led to satisfactory long-term results. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - November 15, 2019 Category: Orthopaedics Tags: Special Technical Article Source Type: research
A Comparative Study Between 2 Intracarpal Partial Shortening Osteotomy Techniques for Type II Lunate Kienbock Disease
Partial capitate shortening is a decompression procedure for the treatment of positive or neutral ulnar variance Kienbock disease. In 45% to 73% of population, the lunate has a separate hamate facet which is also known as a type II lunate. We hypothesized that capitate shortening alone may not ensure adequate decompression of type II lunate, therefore, an added hamate shortening was performed aiming at a better distal unloading in these situations. Thirty Kienbock patients, stage II, type II lunate, and ulna positive or neutral variance, were recruited in this study, Half of which underwent an isolated partial capitate ost...
Source: Techniques in Orthopaedics - November 15, 2019 Category: Orthopaedics Tags: Novel Research Methods and Models Source Type: research
Cancer Stem Cells and Osteosarcoma: Opportunities and Limitations
Osteosarcoma (OS) is the most common primary bone malignancy and is a leading cause of cancer-related death in children and young adults. Combination chemotherapy developed 3 decades ago significantly improved long-term survival compared to surgery alone. However, despite notable tumor cytoreduction and remission, the 5-year survival rate has remained static at ∼70% since, and the surviving patients have high chemoresistance with sustained risk of recurrent OS that has propensity to metastasize. After metastasis, the 5-year survival rate is abysmally low (∼10% to 20%). Emerging new evidence has revealed that within the...
Source: Techniques in Orthopaedics - November 15, 2019 Category: Orthopaedics Tags: Symposium Source Type: research
Stem Cells for the Treatment of Intervertebral Disk Degeneration
Low back pain and neck pain are the first and fourth leading causes, respectively, of years lived with disability. The treatment of intervertebral disk degeneration remains a significant challenge. While there are still many obstacles to overcome, the use of stem cells for the treatment of disk degeneration has emerged as one of the most promising and exciting techniques to restore the structure and function of the degenerated disk. The use of stem cells in treating intervertebral disk disease as well as the obstacles that remain are reviewed here in an evidence-based manner. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - November 15, 2019 Category: Orthopaedics Tags: Symposium Source Type: research
Use of Mesenchymal Stem/Stromal Cells for Pediatric Orthopedic Applications
Cell-based therapies using mesenchymal stem/stromal cells (MSCs) have been extensively investigated both in preclinical and clinical settings. Because of their multipotency, MSCs have initially been expected to regenerate tissues by differentiating into native tissue cells. However, accumulating evidence suggests that the observed clinical benefits are largely from the trophic effects of MSCs. In pilot studies, systemic infusion of MSCs has been shown to clinically improve patients with osteogenesis imperfecta and hypophosphatasia even though donor cell engraftment was minimal, suggesting that the trophic effects of MSCs l...
Source: Techniques in Orthopaedics - November 15, 2019 Category: Orthopaedics Tags: Symposium Source Type: research
Allogeneic Versus Autologous Injectable Mesenchymal Stem Cells for Knee Osteoarthritis: Review and Current Status
Conclusions:
MSC therapies in the treatment of knee OA are safe and have shown promising results but the available studies are limited. At this time, no definitive recommendations can be made regarding which MSC source to use. Allogeneic MSCs offer theoretical advantages over autologous MSCs, especially in ease of use and consistency of product, but there are concerns regarding cell viability and vitality, as well as the body’s response to nonautologous products. Future clinical trials should focus on randomized head-to-head comparisons of MSC sources as well as the use of multiple injections for patients with knee OA....
Source: Techniques in Orthopaedics - November 15, 2019 Category: Orthopaedics Tags: Symposium Source Type: research
