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What Is the Timing of General Health Adverse Events That Occur After Total Joint Arthroplasty?
CONCLUSIONS: As lengths of hospital stay after TJA continue to decrease, our findings suggest that caution is in order because several acute and immediately life-threatening findings, including myocardial infarction and pulmonary embolism, might occur after discharge. Furthermore, the timing of surgical site infection and sepsis suggests that even the 30-day followup afforded by the ACS-NSQIP may not be sufficient to study the latest occurring adverse events. Additionally, both pulmonary embolism and deep vein thrombosis tend to occur earlier after TKA than THA, and this should guide clinical surveillance efforts in patien...
Source: Clinical Orthopaedics and Related Research - January 3, 2017 Category: Orthopaedics Authors: Bohl DD, Ondeck NT, Basques BA, Levine BR, Grauer JN Tags: Clin Orthop Relat Res Source Type: research

What Adverse Events and Injuries Are Cited in Anesthesia Malpractice Claims for Nonspine Orthopaedic Surgery?
CONCLUSIONS: Nonspine orthopaedic anesthesia malpractice claims more frequently cited nerve injury and events arising from the use of regional anesthesia than other surgical anesthesia malpractice claims. This may reflect the frequency of regional anesthesia in orthopaedic cases rather than increased risk of injury associated with regional techniques. When neuraxial procedures and anticoagulation regimens are used concurrently, care pathways should emphasize clear lines of responsibility for coordination of care and early investigation of any unusual neurologic findings that might indicate neuraxial hematoma. We do not hav...
Source: Clinical Orthopaedics and Related Research - March 1, 2017 Category: Orthopaedics Authors: Kent CD, Stephens LS, Posner KL, Domino KB Tags: Clin Orthop Relat Res Source Type: research

Are Patients Who Undergo THA for Infection at Higher Risk for 30-day Complications?
CONCLUSIONS: Patients undergoing revision THA for infection undergo reoperation and experience major complications more frequently in a 30-day episode of care than patients undergoing aseptic revision THA. Without risk adjustment to existing alternative payment and quality reporting models, providers may experience a disincentive to care for patients with infected THAs, who may face difficulties with access to care. LEVEL OF EVIDENCE: Level III, therapeutic study. PMID: 31268424 [PubMed - in process]
Source: Clinical Orthopaedics and Related Research - June 30, 2019 Category: Orthopaedics Authors: Boniello AJ, Lieber AM, Courtney PM Tags: Clin Orthop Relat Res Source Type: research

In-hospital Complications Are More Likely to Occur After Reverse Shoulder Arthroplasty Than After Locked Plating for Proximal Humeral Fractures
CONCLUSION: The increased in-hospital risk for major adverse events and surgical complications may moderate the enthusiasm associated with RTSA for proximal humeral fractures in patients 65 years and older. Treatment decisions should be based on individual risk estimation to avoid potential harmful events. Future studies must include long-term outcomes and quality of life to enlighten these findings in a broader context.LEVEL OF EVIDENCE: Level III, therapeutic study.PMID:33938479 | DOI:10.1097/CORR.0000000000001776
Source: Clinical Orthopaedics and Related Research - May 3, 2021 Category: Orthopaedics Authors: Jeanette K öppe Josef Stolberg-Stolberg Robert Rischen Andreas Faldum Michael J Raschke J Christoph Katthagen Source Type: research

No Difference in Blood Loss and Risk of Transfusion Between Patients Treated with One or Two Doses of Intravenous Tranexamic Acid After Simultaneous Bilateral TKA
CONCLUSION: The findings of this study suggest that a single dose of intravenous TXA may be adequate to control excessive blood loss and reduce blood transfusion in simultaneous bilateral TKA. Despite its short half-life, TXA still appears to be effective in this demanding procedure without requiring prolonged plasma concentrations obtained from multiple doses. Additional high-quality studies are still needed to determine the most appropriate dosing regimen.LEVEL OF EVIDENCE: Level III, therapeutic study.PMID:35302971 | DOI:10.1097/CORR.0000000000002037
Source: Clinical Orthopaedics and Related Research - March 18, 2022 Category: Orthopaedics Authors: Jeffrey M Wilde Steven N Copp Kace A Ezzet Adam S Rosen Richard H Walker Julie C McCauley Audree S Evans William D Bugbee Source Type: research

A Tool to Estimate Risk of 30-day Mortality and Complications After Hip Fracture Surgery: Accurate Enough for Some but Not All Purposes? A Study From the ACS-NSQIP Database
CONCLUSION: The models of mortality and complications we developed may be accurate enough for some uses, especially personalizing informed consent and shared decision-making with patient-specific risk estimates. However, the high false discovery rate suggests the models should not be used to restrict access to surgery for high-risk patients. Deciding which measures of accuracy to prioritize and what is "accurate enough" depends on the clinical question and use of the predictions. Discrimination and calibration are commonly used measures of overall model accuracy but may be poorly suited to certain clinical questions and ap...
Source: Clinical Orthopaedics and Related Research - July 28, 2022 Category: Orthopaedics Authors: Alex H S Harris Amber W Trickey Hyrum S Eddington Carolyn D Seib Robin N Kamal Alfred C Kuo Qian Ding Nicholas J Giori Source Type: research

Child-Pugh Class B or C Liver Disease Increases the Risk of Early Mortality in Patients With Hepatitis C Undergoing Elective Total Joint Arthroplasty Regardless of Treatment Status
CONCLUSION: Patients with HCV and a Child-Pugh Class B or C at the time of elective TJA had substantially increased odds of death, regardless of liver function, cirrhosis, age, Model for End-Stage Liver Disease level, HCV treatment, and viral load status. This is similar to the risk of early mortality observed in patients with chronic liver disease undergoing abdominal and cardiac surgery. Surgeons should avoid these major elective procedures in patients with Child-Pugh Class B or C whenever possible. For patients who feel their arthritic symptoms and pain are unbearable, surgeons need to be clear that the risk of death is...
Source: Clinical Orthopaedics and Related Research - March 24, 2023 Category: Orthopaedics Authors: Kyle H Cichos Eric Jordan Kian Niknam Antonia F Chen Erik N Hansen Gerald McGwin Elie S Ghanem Source Type: research

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