M2 microglia-derived exosome-loaded electroconductive hydrogel for enhancing neurological recovery after spinal cord injury.

Electroconductive hydrogels offer a promising avenue for enhancing the repair efficacy of spinal cord injuries (SCI) by restoring disrupted electrical signals along the spinal cord's conduction pathway. Nonetheless, the application of hydrogels composed of diverse electroconductive materials has demonstrated limited capacity to mitigate the post-SCI inflammatory response. Recent research has indicated that the transplantation of M2 microglia effectively fosters SCI recovery by attenuating the excessive inflammatory response. Exosomes (Exos), small vesicles discharged by cells carrying similar biological functions to their originating cells, present a compelling alternative to cellular transplantation. This investigation endeavors to exploit M2 microglia-derived exosomes (M2-Exos) successfully isolated and reversibly bonded to electroconductive hydrogels through hydrogen bonding for synergistic promotion of SCI repair to synergistically enhance SCI repair. In vitro experiments substantiated the significant capacity of M2-Exos-laden electroconductive hydrogels to stimulate the growth of neural stem cells and axons in the dorsal root ganglion and modulate microglial M2 polarization. Furthermore, M2-Exos demonstrated a remarkable ability to mitigate the initial inflammatory reaction within the injury site. When combined with the electroconductive hydrogel, M2-Exos worked synergistically to expedite neuronal and axonal regeneration, substantially enhancing the functional recovery of rats afflicted with SCI. These findings underscore the potential of M2-Exos as a valuable reparative factor, amplifying the efficacy of electroconductive hydrogels in their capacity to foster SCI rehabilitation.

Risk factors for perioperative blood transfusion in patients undergoing total laparoscopic hysterectomy.

PURPOSE: The goal is to identify risk factors associated with receiving a blood transfusion during the perioperative period in patients who undergo total laparoscopic hysterectomy (TLH) using a large-scale national database. METHODS: In this retrospective analysis, data from the Nationwide Inpatient Sample (NIS) was utilized to review the medical records of all patients who underwent TLH from 2010 to 2019. The researchers identified patients who had received a blood transfusion during the perioperative period and compared with those who had not. The subsequent factors associated with blood transfusion were examined: hospital characteristics (type of admission and payer, patient demographics (age and race), bed size, teaching status, location, and region of hospital), length of stay (LOS), total charges during hospitalization, in-hospital mortality, comorbidities, and perioperative complications. The data was analyzed using descriptive statistics. The independent risk factors of perioperative blood transfusion after TLH was identified by performing multivariate logistic regression. RESULTS: A total of 79,933 TLH were captured from the NIS database, among which 3433 (4.40%) patients received a perioperative blood transfusion. TLH patients affected by blood transfusion were 2 days longer hospital stays (P < 0.001), higher overall costs (P < 0.001), the patients who received a transfusion after a long-term hospitalization had a significantly higher rate of mortality (0.5% vs. 0.1%; P < 0.001). Perioperative blood transfusion after TLH was associated with chronic blood loss anemia, deficiency anemia, coagulopathy, congestive heart failure, fluid and electrolyte disorders, renal failure, metastatic cancer, sepsis, weight loss, deep vein thrombosis, gastrointestinal hemorrhage, shock, acute myocardial infarction, and pneumonia, stroke, hemorrhage, pulmonary embolism, and disease of the genitourinary system. CONCLUSION: Studying the risk factors of perioperative blood transfusion after TLH is advantageous in order to ensure proper management and optimize outcomes.

A retrospective analysis of the incidence and risk factors of perioperative urinary tract infections after total hysterectomy.

INTRODUCTION: Perioperative urinary tract infections (PUTIs) are common in the United States and are a significant contributor to high healthcare costs. There is a lack of large studies on the risk factors for PUTIs after total hysterectomy (TH). METHODS: We conducted a retrospective study using a national inpatient sample (NIS) of 445,380 patients from 2010 to 2019 to analyze the risk factors and annual incidence of PUTIs associated with TH perioperatively. RESULTS: PUTIs were found in 9087 patients overall, showing a 2.0% incidence. There were substantial differences in the incidence of PUTIs based on age group (P < 0.001). Between the two groups, there was consistently a significant difference in the type of insurance, hospital location, hospital bed size, and hospital type (P < 0.001). Patients with PUTIs exhibited a significantly higher number of comorbidities (P < 0.001). Unsurprisingly, patients with PUTIs had a longer median length of stay (5 days vs. 2 days; P < 0.001) and a higher in-hospital death rate (from 0.1 to 1.1%; P < 0.001). Thus, the overall hospitalization expenditures increased by $27,500 in the median ($60,426 vs. $32,926, P < 0.001) as PUTIs increased medical costs. Elective hospitalizations are less common in patients with PUTIs (66.8% vs. 87.6%; P < 0.001). According to multivariate logistic regression study, the following were risk variables for PUTIs following TH: over 45 years old; number of comorbidities (≥ 1); bed size of hospital (medium, large); teaching hospital; region of hospital(south, west); preoperative comorbidities (alcohol abuse, deficiency anemia, chronic blood loss anemia, congestive heart failure, diabetes, drug abuse, hypertension, hypothyroidism, lymphoma, fluid and electrolyte disorders, metastatic cancer, other neurological disorders, paralysis, peripheral vascular disorders, psychoses, pulmonary circulation disorders, renal failure, solid tumor without metastasis, valvular disease, weight loss); and complications (sepsis, acute myocardial infarction, deep vein thrombosis, gastrointestinal hemorrhage, pneumonia, stroke, wound infection, wound rupture, hemorrhage, pulmonary embolism, blood transfusion, postoperative delirium). CONCLUSIONS: The findings suggest that identifying these risk factors can lead to improved preventive strategies and management of PUTIs in TH patients. Counseling should be done prior to surgery to reduce the incidence of PUTIs. THE MANUSCRIPT ADDS TO CURRENT KNOWLEDGE: In medical practice, the identification of risk factors can lead to improved patient prevention and treatment strategies. We conducted a retrospective study using a national inpatient sample (NIS) of 445,380 patients from 2010 to 2019 to analyze the risk factors and annual incidence of PUTIs associated with TH perioperatively. PUTIs were found in 9087 patients overall, showing a 2.0% incidence. We found that noted increased length of hospital stay, medical cost, number of pre-existing comorbidities, size of the hospital, teaching hospitals, and region to also a play a role in the risk of UTI's. CLINICAL TOPICS: Urogynecology.

Incidence and related risk factors for postoperative delirium following revision total knee arthroplasty: a retrospective nationwide inpatient sample database study.

BACKGROUND: Postoperative delirium (POD) is a common surgical complication. However, the incidence and risk factors associated with postoperative delirium after revision total knee arthroplasty (rTKA) have not been comprehensively explored through extensive national databases. METHODS: Utilizing the National Inpatient Sample (NIS), the largest comprehensive U.S. hospital healthcare database, we undertook a retrospective investigation involving 127,400 patients who underwent rTKA between 2010 and 2019. We assessed various aspects, including patient demographics, hospital characteristics, pre-existing medical conditions, and perioperative complications. RESULTS: The overall incidence of postoperative delirium (POD) in patients undergoing rTKA between 2010 and 2019 was 0.97%. The highest incidence rate of 1.31% was recorded in 2013. Notably, this patient cohort demonstrated advanced age, increased burden of co-morbidities, prolonged hospital stays, increased hospitalization costs, and elevated in-hospital mortality rates (P < 0.001). Moreover, non-elective admissions, non-private insurance payments, and a preference for teaching hospitals were commonly observed among these patients. During their hospitalization, individuals who developed delirium subsequent to rTKA were more prone to experiencing certain perioperative complications. These complications encompassed medical issues like acute myocardial infarction, continuous invasive mechanical ventilation, postoperative shock, sepsis, stroke and other medical problems. Additionally, surgical complications including hemorrhage / seroma / hematoma, irrigation and debridement, prosthetic joint infection, periprosthetic fracture, and wound dehiscence / nonunion were noted. Several risk factors were found to be linked with the development of POD. These included advanced age (≥ 75 years), alcohol abuse, coagulation disorders, congestive heart failure, depression, fluid and electrolyte imbalances, and more. Conversely, female sex, having private insurance, and undergoing elective hospitalization emerged as protective factors against POD. CONCLUSION: Our findings suggest that the general prevalence of POD in rTKA is relatively low according to NIS. There was a significant connection between the POD of rTKA and advanced age, prolonged length of stay (LOS), more in-patients' costs, higher in-hospital mortality rate, increased comorbidities, postoperative medical complications and postoperative surgical complications. This study helps to understand the risk factors associated with POD to improve poor outcomes.

Analysis of the incidence and risk factors of blood transfusion in total knee revision: a retrospective nationwide inpatient sample database study.

OBJECTIVE: This study sought to determine the incidence and risk factors of blood transfusion among patients undergoing total knee revision (TKR) using a nationwide database. METHODS: A retrospective data analysis was conducted based on the Nationwide Inpatient Sample (NIS), enrolling patients who underwent TKR from 2010 to 2019 with complete information. The patients were divided into two groups based on whether they received blood transfusion or not. The demographic characteristics (race, sex, and age), length of stay (LOS), total charge of hospitalization, hospital characteristics (admission type, insurance type, bed size, teaching status, location, and region of hospital), hospital mortality, comorbidities, and perioperative complications were analyzed. Finally, we conducted univariate and multivariate logistic regression to identify factors that were associated with TKR patients to require blood transfusion. RESULTS: The NIS database included 115,072 patients who underwent TKR. Among them, 14,899 patients received blood transfusion, and the incidence of blood transfusion was 13.0%. There was a dramatic decrease in the incidence over the years from 2010 to 2019, dropping from 20.4 to 6.5%. TKR patients requiring transfusions had experienced longer LOS, incurred higher total medical expenses, utilized Medicare more frequently, and had increased in-hospital mortality rates (all P < 0.001). Independent predictors for blood transfusion included advanced age, female gender, iron-deficiency anemia, rheumatoid disease, chronic blood loss anemia, congestive heart failure, coagulopathy, uncomplicated diabetes, lymphoma, fluid and electrolyte disorders, metastatic carcinoma, other neurological diseases, paralysis, peripheral vascular disorders, pulmonary circulation disorders, renal failure, valvular disease, and weight loss. In addition, risk factors for transfusion in TKR surgery included sepsis, acute myocardial infarction, deep vein thrombosis, pulmonary embolism, gastrointestinal bleeding, heart failure, renal insufficiency, pneumonia, wound infection, lower limb nerve injury, hemorrhage/seroma/hematoma, wound rupture/non healing, urinary tract infection, acute renal failure, and postoperative delirium. CONCLUSIONS: Our findings highlight the importance of recognizing the risk factors of blood transfusion in TKR to reduce the occurrence of adverse events.

Impact of diabetic kidney disease on post-operative complications after primary elective total hip arthroplasty: a nationwide database analysis.

BACKGROUND: The high prevalence of diabetic kidney disease (DKD) in the United States necessitates further investigation into its impact on complications associated with total hip arthroplasty (THA). This study utilizes a large nationwide database to explore risk factors in DKD cases undergoing THA. METHODS: This research utilized a case-control design, leveraging data from the national inpatient sample for the years 2016 to 2019. Employing propensity score matching (PSM), patients diagnosed with DKD were paired on a 1:1 basis with individuals free of DKD, ensuring equivalent age, sex, race, Elixhauser Comorbidity Index (ECI), and insurance coverage. Subsequently, comparisons were drawn between these PSM-matched cohorts, examining their characteristics and the incidence of post-THA complications. Multivariate logistic regression analysis was then employed to evaluate the risk of early complications after surgery. RESULTS: DKD's prevalence in the THA cohort was 2.38%. A 7-year age gap separated DKD and non-DKD patients (74 vs. 67 years, P < 0.0001). Additionally, individuals aged above 75 exhibited a substantial 22.58% increase in DKD risk (49.16% vs. 26.58%, P < 0.0001). Notably, linear regression analysis yielded a significant association between DKD and postoperative acute kidney injury (AKI), with DKD patients demonstrating 2.274-fold greater odds of AKI in contrast with non-DKD individuals (95% CI: 2.091-2.473). CONCLUSIONS: This study demonstrates that DKD is a significant risk factor for AKI in patients undergoing total hip arthroplasty. Optimizing preoperative kidney function through appropriate interventions might decrease the risk of poor prognosis in this population. More prospective research is warranted to investigate the potential of targeted kidney function improvement strategies in reducing AKI rates after THA. The findings of this study hold promise for enhancing preoperative counseling by surgeons, enabling them to provide DKD patients undergoing THA with more precise information regarding the risks associated with their condition.

Incidence and risk factors of postoperative delirium following hepatic resection: a retrospective national inpatient sample database study.

BACKGROUND: Postoperative delirium (POD) is a common complication after major surgery and can cause a variety of adverse effects. However, no large-scale national database was used to assess the occurrence and factors associated with postoperative delirium (POD) following hepatic resection. METHODS: Patients who underwent hepatic resection from 2015 to 2019 were screened using the International Classification of Diseases (ICD) 10th edition clinical modification code from the National Inpatient Sample (NIS) Database. Peri-operative factors associated with delirium were screened and underwent statistical analysis to identify independent predictors for delirium following hepatic resection. RESULTS: A total of 80,070 patients underwent hepatic resection over a five-year period from 2015 to 2019. The overall occurrence of POD after hepatic resection was 1.46% (1039 cases), with a slight upward trend every year. The incidence of elective admission was 6.66% lower (88.60% vs. 81.94%) than that of patients without POD after hepatic resection and 2.34% (45.53% vs. 43.19%) higher than that of patients without POD in teaching hospitals (P < 0.001). In addition, POD patients were 6 years older (67 vs. 61 years) and comprised 9.27% (56.69% vs. 47.42%) more male patients (P < 0.001) compared to the unaffected population. In addition, the occurrence of POD was associated with longer hospitalization duration (13 vs. 5 days; P < 0.001), higher total cost ($1,481,89 vs. $683,90; P < 0.001), and higher in-hospital mortality (12.61% vs. 4.11%; P < 0.001). Multivariate logistic regression identified hepatic resection-independent risk factors for POD, including non-elective hospital admission, teaching hospital, older age, male sex, depression, fluid and electrolyte disorders, coagulopathy, other neurological disorders, psychoses, and weight loss. In addition, the POD after hepatic resection has been associated with sepsis, dementia, urinary retention, gastrointestinal complications, acute renal failure, pneumonia, continuous invasive mechanical ventilation, blood transfusion, respiratory failure, and wound dehiscence / non-healing. CONCLUSION: Although the occurrence of POD after hepatic resection is relatively low, it is beneficial to investigate factors predisposing to POD to allow optimal care management and improve the outcomes of this patient population.

Bone Homeostasis Modulating Orthopedic Adhesive for the Closed-Loop Management of Osteoporotic Fractures.

Patients with osteoporotic fractures often require effective fixation and subsequent bone repair. However, currently available materials are often limited functionally, failing to improve this cohort's outcomes. Herein, kaempferol-loaded mesoporous bioactive glass nanoparticles (MBGNs)-doped orthopedic adhesives are prepared to assist osteoporotic fracture fixation and restore dysregulated bone homeostasis, including promoting osteoblast formation while inhibiting osteoclastic bone-resorbing activity to synergistically promote osteoporotic fracture healing. The injectability, reversible adhesiveness and malleable properties endowed the orthopedic adhesives with high flexibility and hemostatic performance to adapt to complex clinical scenarios. Moreover, Ca2+ and SiO4 4- ions released from MBGNs can accelerate osteogenesis via the PI3K/AKT pathway, while kaempferol mediated osteoclastogenesis inhibition and can slow down the bone resorption process through NF-κB pathway, which regulated bone regeneration and remodeling. Importantly, implementing the orthopedic adhesive is validated as an effective closed-loop management approach in restoring the dysregulated bone homeostasis of osteoporotic fractures.

A retrospective analysis of the incidence of postoperative delirium and the importance of database selection for its definition.

BACKGROUND: Postoperative delirium (POD) is a common complication after major surgery, resulting in various adverse reactions. However, incidence and risk factors associated with POD after shoulder arthroplasty (SA) have not been well studied using a large-scale national database. METHODS: A retrospective database analysis was performed based on the Nationwide Inpatient Sample (NIS) from 2005 to 2014, the largest fully paid hospital care database in the United States. Patients undergoing SA were included. The patient's demographics, comorbidities, length of stay (LOS), total costs, type of insurance, type of hospital, in-hospital mortality, and medical and surgical perioperative complications were assessed. RESULTS: A total of 115,147 SA patients were obtained from the NIS database. The general incidence of delirium after SA was 0.89%, peaking in 2010. Patients with delirium after SA had more comorbidities, prolonged LOS, increased hospitalization costs, and higher in-hospital mortality (P < 0.0001). These patients were associated with medical complications during hospitalization, including acute renal failure, acute myocardial infarction, pneumonia, pulmonary embolism, stroke, urinary tract infection, sepsis, continuous invasive mechanical ventilation, blood transfusion, and overall perioperative complications. Risk factors associated with POD include advanced age, neurological disease, depression, psychosis, fluid and electrolyte disturbances, and renal failure. Protective factors include elective hospital admissions and private insurance. CONCLUSION: The incidence of delirium after SA is relatively low. Delirium after SA was associated with increased comorbidities, LOS, overall costs, Medicare coverage, mortality, and perioperative complications. Studying risk factors for POD can help ensure appropriate management and mitigate its consequences. Meanwhile, we found some limitations of this type of research and the need to establish a country-based POD database, including further clearly defining the diagnostic criteria for POD, investigating risk factors and continuing to collect data after discharge (30 days or more), so as to further improve patient preoperative optimization and management.

Comparisons of in-hospital complications between total hip arthroplasty and hip resurfacing arthroplasty.

BACKGROUND: Hip resurfacing arthroplasty (HRA) is a less common but effective alternative method to total hip arthroplasty (THA) for hip reconstruction. In this study, we investigated the incidences of in-hospital complications between patients who had been subjected to THA and HRA. METHODS: The National Inpatient Sample data that had been recorded from 2005 to 2014 was used in this study. Based on the International Classification of Disease, Ninth Revision, Clinical Modification, patients who underwent THA or HRA were included. Data on demographics, preoperative comorbidities, length of hospital stay, total charges, and in-hospital mortality and complications were compared. Multiple logistic regression analysis was used to determine whether different surgical options are independent risk factors for postoperative complications. RESULTS: A total of 537,506 THAs and 9,744 HRAs were obtained from the NIS database. Patients who had been subjected to HRA exhibited less preoperative comorbidity rates, shorter length of stay and extra hospital charges. Moreover, HRA was associated with more in-hospital prosthesis loosening. Notably, patients who underwent HRA were younger and presented less preoperative comorbidities but did not show lower incidences in most complications. CONCLUSIONS: The popularity of HRA gradually reduced from the year 2005 to 2014. Patients who underwent HRA were more likely to be younger, male, have less comorbidities and spend more money on medical costs. The risk of in-hospital prosthesis loosening after HRA was higher. The HRA-associated advantages with regards to most in-hospital complications were not markedly different from those of THA. In-hospital complications of HRA deserve more attention from surgeons.

Delayed surgery is associated with adverse outcomes in patients with hip fracture undergoing hip arthroplasty.

BACKGROUND: Hip arthroplasty (HA) is one of the most effective procedures for patients with hip fractures. The timing of surgery played a significant role in the short-term outcome for these patients, but conflicting evidence has been found. METHODS: The Nationwide Inpatient Sample database was investigated from 2002 to 2014 and identified 247,377 patients with hip fractures undergoing HA. The sample was stratified into ultra-early (0 day), early (1-2 days) and delayed (3-14 days) groups based on time to surgery. Yearly trends, postoperative surgical and medical complications, postoperative length of hospital stay (POS) and total costs were compared after propensity scores were matched between groups by demographics and comorbidity. RESULTS: From 2002 to 2014, the percentage of hip fracture patients who underwent HA increased from 30.61 to 31.98%. Early surgery groups showed fewer medical complications but higher surgical complications. However, specific complication evaluation showed both ultra-early and early groups decreased most of the surgery and medical complications with increasing post hemorrhagic anemia and fever. Medical complications were also reduced in the ultra-early group, but surgical complications increased. Early surgery groups reduced the POS by 0.90 to 1.05 days and total hospital charges by 32.6 to 44.9 percent than delayed surgery groups. Ultra-early surgery showed no benefit from POS than early group, but reduced total hospital charges by 12.2 percent. CONCLUSION: HA surgery performed within 2 days showed more beneficial effects on adverse events than delayed surgery. But surgeons should be cognizant of the potential increased risks of mechanical complications and post-hemorrhagic anemia.

Influence of frailty and its interaction with comorbidity on outcomes among total joint replacement.

BACKGROUND: Patients with frailty get more and more attention in clinical practice. Yet, no large-scale studies have explored the impact of frailty on the perioperative acute medical and surgical complications following TJA. what is more, comorbid diseases may lead, at least additively, to the development of frailty. There also no studies to find the possible interaction between comorbidity and frailty on the postoperative complications after TJA. METHODS: Discharge data of 2,029,843 patients who underwent TJA from 2005 to 2014 from the National Inpatient Sample (NIS) database, which was analyzed using cross-tabulations and multivariate regression modeling. Frailty was defined based on frailty-defining diagnosis clusters from frailty-defining diagnosis indicator of Johns Hopkins Adjusted Clinical Groups. RESULTS: Among patients who underwent total joint replacement surgeries, 50,385 (2.5%) were identified as frail. Frailty is highly associated with old age, especially for those over the age of 80, meanwhile females and black races have a high Charlson comorbidity index (CCI) of ≥ 3, together with emergency/urgent admission and teaching hospital. While comorbidity is associated with greater odds of acute medical complications, and frailty has a better predictive effect on in-hospital deaths, acute surgical complications. Furthermore, frailty did not show an enhancement in the predictive power of the Charlson comorbidity score for postoperative complications or in-hospital deaths but postoperative LOS and hospitalization costs. CONCLUSION: Frailty can be used to independently predicted postoperative surgical and medical complications, which also has a synergistic interaction with comorbidity for patients who are preparing to undergo TJA.

Complications of primary total hip arthroplasty among patients with rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and primary osteoarthritis.

BACKGROUND: Limited information exists comparing the perioperative complications of the different inflammatory arthropathies (IAs) after total hip arthroplasty (THA). Our study was aimed to (1) compare perioperative complications and (2) determine the most common complications between the different IA subtypes compared with patients with primary osteoarthritis (OA) undergoing primary THA and (3) find whether the difference in postoperative complications also exists between different IA after THA. METHODS: The Nationwide Inpatient Sample (NIS) was used to identify patients with Rheumatoid arthritis (RA), psoriatic arthritis, ankylosing spondylitis (AS), and primary OA undergoing unilateral THA between 2005 and 2014. Preoperative diagnosis, comorbidities, and postoperative complications were determined using the International Classification of Disease Clinical Modification version 9 codes. The prevalence of perioperative complications was compared between patients with IA and primary OA and between patients with different IA. RESULTS: When compared with patients with primary OA, patients with RA had significantly more postoperative surgical and medical complications. Yet there are just several medical complications differences exist between PA and primary OA or AS and primary OA, including stroke and acute renal failure for psoriatic arthritis and urinary tract infection and pneumonia for AS. What is more, there were also several differences in perioperative medical complications seen in patients with different IA. CONCLUSION: Except for patients with RA, the differences in perioperative complications was small between patients with IA and primary OA and between patients with different types of IA.

Incidence and risk factors associated with hospital-acquired pressure ulcers following total hip arthroplasty: A retrospective nationwide inpatient sample database study.

AIM: To examine the incidence and risk factors associated with hospital-acquired pressure ulcers (HAPUs) following total hip arthroplasty (THA) using a large-scale national database. MATERIAL AND METHODS: A retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2005 to 2014. Patients who underwent THA were included. Patient demographics, hospital characteristics, length of stay (LOS), total charges during hospitalization, in-hospital mortality, preoperative comorbidities, and perioperative complications were assessed. RESULTS: The general incidence of HAPUs after THA was 0.05%, with a fluctuating trend annually. Patients suffered from HAPUs were older, less likely through elective admission, more likely in large hospital, more usage of Medicare, and less possibly paying via Private insurance. Additionally, the occurrence of HAPUs was associated with more preoperative comorbidities, longer LOS, extra total charges, and higher in-hospital mortality. Risk factors associated with HAPUs included advanced age (≥75 years), large hospital, multiple comorbidities (n ≥ 3), diabetes with chronic complications, drug abuse, liver disease, fluid and electrolyte disorders, metastatic cancer, peripheral vascular disorders, psychoses, chronic renal failure, peptic ulcer disease, and weight loss. Besides, HAPUs were associated with inflammatory arthritis and femoral neck fracture (compared with primary/secondary osteoarthritis), frailty/senility, osteoporosis, acute renal failure, pneumonia, postoperative delirium, urinary tract infection, deep vein thrombosis, sepsis/septicemia, wound dehiscence/non-healing surgical wound, periprosthetic joint infection, and mechanical prosthesis-related complications. CONCLUSION: It is beneficial to study the risk factors associated with HAPUs after THA to ensure the preventive management and optimize outcomes although a low incidence was identified.

Impact of valvular heart disease on hip replacement: a retrospective nationwide inpatient sample database study.

BACKGROUND: To study the impact of valvular heart disease (VHD) on hip replacement, particularly the clinical impactions of aortic stenosis before total/partial hip arthroplasty. METHODS: This was a retrospective cohort study. Data on patients who had undergone hip replacement from 2005 to 2014 were extracted from the NIS database. Independent t test and chi-square test were used to analyze the essential characteristics of patients. Multivariate regression was used to estimate the correlation among demographics, comorbidities, complications, hospitalization costs, and time. RESULTS: VHD accounted for 5.56% and AS accounted for 0.03% of the patients before hip replacement surgeries. Patients with VHD before hip replacement are related to the following characteristics: female patients (odds ratio [OR] = 1.15 [1.12-1.18]), elective admission (OR = 0.78 [0.76-0.80]), Charlson Comorbidity Index ≥3 (OR = 1.06 [1.03-1.08]), large-volume hospitals (OR = 1.13 [1.1-1.2]), teaching hospitals (OR = 5 4.4 [2.9-6.7]), and hospital location in urban areas (OR = 1.22 [1.2-1.3]). In addition, VHD is a risk factor for mortality and some acute postoperative medical complications, such as acute cardiac event (OR = 2.96 [2.87-3.04]), acute pulmonary edema (OR = 1.13 [1.06-1.21]), acute cerebrovascular event (OR = 1.22 [1.16-1.74]), and acute renal failure (OR = 1.22 [1.17-1.27]). It also has an impact on DVT/PE (OR = 0.89 [0.8-0.99]). Patients with AS before hip replacement have basic demographic characteristics like those of hip replacement patients with valvular disease. Patients with AS are older than those without AS before surgery (OR = 3.28 [2.27-4.75) and are related to the following characteristics: female patients (OR = 1.92 [1.32-2.8]) and elective admission (OR = 0.51 [0.36-0.75]). The perioperative period is limited to acute postoperative complications, such as acute cardiac events (OR = 2.50 [1.76-3.53]) and acute hepatic failure (OR = 7.69 [1.8-32.89]). Both valvular diseases and AS are associated with a higher mortality rate and hospitalization cost. CONCLUSION: VHD independently predicted mortality rate and surgical and medical complications after total/partial hip arthroplasty.

Incidence and risk factors associated with postoperative delirium following primary elective total hip arthroplasty: a retrospective nationwide inpatient sample database study.

BACKGROUND: Postoperative delirium is a common complication following major surgeries, leading to a variety of adverse effects. However, there is a paucity of literatures studying the incidence and risk factors associated with delirium after primary elective total hip arthroplasty (THA) using a large-scale national database. METHODS: A retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2009 to 2014. Patients who underwent primary elective THA were included. Patient demographics, preoperative comorbidities, length of hospital stay (LOS), total charges, in-hospital mortality, and major and minor perioperative complications were evaluated. RESULTS: A total of 388,424 primary elective THAs were obtained from the NIS database, and the general incidence of delirium after THA was 0.90%. Patients with delirium after THA presented more preoperative comorbidities, longer LOS, extra hospital charges, and higher in-hospital mortality rate (P < 0.001). Delirium following THA was associated with major complications during hospitalization including acute renal failure and pneumonia. Preoperative risk factors associated with postoperative delirium included advanced age, alcohol or drug abuse, depression, neurological disorders, psychoses, fluid and electrolyte disorders, diabetes, weight loss, deficiency anemia, coagulopathy, hypertension, congestive heart failure, valvular disease, pulmonary circulation disorders, peripheral vascular disorders, and renal failure. Both female and obesity were detected to be protective factors. CONCLUSIONS: The results of our study identified a relatively low incidence of delirium after primary elective THA, which is as reported in the NIS and not necessarily the surgical population as a whole. Postoperative delirium of THA was associated with increased preoperative comorbidities, LOS, total charges, in-hospital mortality, and major perioperative complications including acute renal failure and pneumonia. It is of benefit to study risk factors associated with postoperative delirium to moderate its consequences.

Incidence and risk factors of in-hospital prosthesis-related complications following total hip arthroplasty: a retrospective Nationwide Inpatient Sample database study.

PURPOSE: The occurrence of prosthesis-related complications (PRCs) after total hip arthroplasty (THA) is devastating, commonly meaning implant failure and revision surgery. The purpose was to examine the incidence and risk factors of in-hospital PRCs following THA using a large-scale national database. METHODS: A retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2005 to 2014. Patients who underwent THA were included. Patient demographics, hospital characteristics, length of stay (LOS), economic indicators, in-hospital mortality, comorbidities, and peri-operative complications were evaluated. RESULTS: A total of 590,122 THAs were obtained from the NIS database. The general incidence of in-hospital PRCs after THA was 1.96%, with a slight downward trend annually. Dislocation was the most common PRCs (0.23%). Patients with PRCs after THA demonstrated increased LOS, total charges, usage of Medicare, and in-hospital mortality. Risk factors of PRCs included advanced age, female, the Hispanic, the Native American, large hospital, teaching hospital, hospital in the South, Medicaid, Self-pay, alcohol abuse, anemia, coagulopathy, rheumatoid diseases, neurological disorders, depression, paralysis, psychosis, diabetes, fluid and electrolyte disorders, congestive heart failure, chronic pulmonary disease, liver disease, metastatic cancer, and weight loss. Additionally, PRCs were associated with avascular necrosis, ankylosing spondylitis, rheumatoid arthritis, femoral neck fracture, dementia, osteoporosis, acute renal failure, acute myocardial infarction, pneumonia, post-operative delirium, urinary tract infection, deep vein thrombosis, transfusion, sepsis, post-operative shock, wound dehiscence, haemorrhage/seroma/haematoma, and nerve injury. CONCLUSION: A relatively low incidence of in-hospital PRCs after THA was identified. It is of benefit to study risk factors of PRCs to ensure the appropriate management and moderate consequences.

Diagnostic performance of microRNAs expression in prostate cancer.

MicroRNAs (miRNAs) have been proposed as ideal diagnostic indicators of prostate cancer (CaP). However, previous studies have reported conflicting results. Therefore, we conducted this meta-analysis to assess the potential diagnostic value of miRNAs for CaP. A systematic literature search was conducted in PubMed and other databases. Results from different studies were pooled using random effects models. The pooled sensitivity (SEN), specificity (SPE), positive and negative likelihood ratios (PLR and NLR, respectively), diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated to evaluate the overall test performance. Between-study heterogeneity was tested using the chi-squared test and the I (2) test. Meta-regression and subgroup analyses were performed to explore the potential sources of heterogeneity. Fifty-eight studies from ten articles, including 669 patients with CaP and 404 controls composed of healthy individuals and patients with benign prostatic hyperplasia (BPH), were included in this meta-analysis. The pooled SEN and SPE were 0.74 (95 % confidence interval (CI) 0.70-0.78) and 0.73 (95 % CI 0.70-0.76), respectively. The pooled PLR was 2.7 (95 % CI 2.4-3.1); NLR was 0.35 (95 % CI 0.30-0.42); and DOR was 8 (95 % CI 6-10). The pooled AUC was 0.79 (95 % CI 0.76-0.83). Subgroup analyses indicated that multiple miRNAs yielded a better diagnostic accuracy. This systematic review suggests that miRNA analysis can significantly improve the overall accuracy of CaP diagnosis. Moreover, using multiple miRNA-based assays could achieve significantly higher accuracy in diagnosing CaP than single miRNA-based assays.