The Effect of Diabetes Mellitus on Revision Discectomy after Single-level Lumbar Discectomy.

Diabetes currently affects over 25 million Americans, with the elderly carrying much of the disease burden. It's well known that diabetes increases the risk of surgical complications, but few studies have analyzed its effects on reoperation rates after single-level lumbar discectomy. Data was obtained using the commercially available Explorys software, which houses de-identified data for several healthcare systems. A database search was conducted to find all patients who'd undergone a lumbar discectomy. Scoliosis, spondylolisthesis, smoking history and obesity were excluded as possible confounding variables, after which 31,210 patients remained. Of them, 950 were found to have undergone a revision discectomy within 2 years. Those with diabetes were found to have a relative risk of 1.29 for revision discectomy compared to those who did not, 95% confidence interval (95% CI) 1.10-1.52, p < 0.002. These findings contribute to the importance of modifiable risk factor assessment preoperatively and their effects on surgical complications. (Journal of Surgical Orthopaedic Advances 29(3):159-161, 2020).

Effect of Nicotine Dependence and Smoking on Revision Diskectomy After Single-Level Lumbar Diskectomy.

Removal of a herniated disk that is causing neural compression is among the most common indications for spinal surgery. Previous population database studies of risk factors for reoperation after this procedure analyzed small to medium numbers of patients. To date, no study has concurrently assessed the effect of modifiable risk factors, such as smoking and nicotine dependence, with a large number of patients. Data were obtained with commercially available software that houses de-identified data for several major US health care systems. A database search was conducted to find all patients who had undergone lumbar diskectomy. Obesity, scoliosis, spondylolisthesis, and depression were excluded as possible confounding variables. The remaining patients were divided into smoking and nonsmoking groups. Those who had undergone revision lumbar diskectomy within 2 years were counted. Pearson's chi-square statistical test was used to determine significance at P<.05. Of the 50 million patient records in the software platform, 53,360 patients were identified who had undergone single-level lumbar diskectomy. Of these, 26,980 fulfilled the inclusion criteria. A total of 890 of those patients had undergone revision lumbar diskectomy within 2 years of their original procedure. Those who smoked were found to have a relative risk of 2.47 compared with nonsmokers (95% confidence interval, 2.17-2.82; P<.0001). Nicotine dependence and smoking had a significant effect on the rate of reoperation. These findings support the importance of preoperative assessment of modifiable risk factors and their effects on surgical complications. [Orthopedics. 2020;43(5):e438-e441.].

The Effect of Obesity on Revision Discectomy After Singlelevel Lumbar Discectomy.

The prevalence of obesity has been rising, creating a major public health concern. While several studies have shown obesity to increase the risk of surgical complications, few have analyzed its effects on reoperation, specifically after singlelevel lumbar discectomy. Data was obtained using the commercially available Explorys software that houses deidentified data for several major healthcare systems. A database search was used to find all patients who had undergone a lumbar discectomy. Scoliosis, spondylolisthesis, smoking history and depression were excluded as possible confounding variables, after which 25,960 patients remained. Of them, 690 were found to have undergone a revision discectomy within 2 years. Those who were obese were found to have a relative risk of 1.64 for revision discectomy compared to those who were nonobese, 95% confidence interval (95%CI) 1.322.03, p 0.0001. These findings contribute to the importance of modifiable risk factor assessment preoperatively and their effects on surgical complications. (Journal of Surgical Orthopaedic Advances 29(1):1012, 2020).

Hypovitaminosis D in Patients Undergoing Shoulder Arthroplasty: A Single-Center Analysis.

Vitamin D is recognized as an essential component in bone health, muscle function, and immune system regulation. This study sought to characterize the prevalence of hypovitaminosis D in patients undergoing total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RSA), and shoulder hemiarthroplasty (HA). Between September 2013 and December 2014, a total of 218 patients undergoing TSA, RSA, and HA by a single surgeon were screened for hypovitaminosis D and retrospectively reviewed. Demographic variables and risk factors were recorded. Overall, 93 shoulder arthroplasty patients (43%) were vitamin D insufficient (<30 ng/mL) and 24 patients (11%) were vitamin D deficient (<20 ng/mL). Body mass index (BMI) had a significant effect on vitamin D levels; BMI of 30 kg/m(2) or greater was associated with lower vitamin D levels (31.5±12.1 ng/mL) compared with patients with a BMI of less than 30 kg/m(2) (36.2±15.7 ng/mL, P ≤.01). The absence of supplementation with vitamin D and calcium prior to serum testing was the most significant risk factor for hypovitaminosis D (odds ratio [OR], 8.234, P<.001). Age, gender, race, smoking status, American Society of Anesthesiologists (ASA) score, procedure, and surgical indication were not significant. This is the largest cohort of shoulder arthroplasty patients screened for hypovitaminosis D. Almost half (43%) of the study population was insufficient, and both the absence of supplementation prior to serum testing and BMI of 30 kg/m(2) or greater were found to be predictive of lower serum 25-hydroxyvitamin D levels. Given the extent of vitamin D involvement in normal musculoskeletal physiology, routine preoperative evaluation is merited. [Orthopedics. 2016; 39(4):e651-e656.].

Resistance trends in Neisseria gonorrhoeae in southwestern Ohio.

BACKGROUND: Fluoroquinolone-resistant Neisseria gonorrhoeae strains originated in Eastern Asia in the 1980s; first appeared in United States during the early 1990 s in Hawaii, and subsequently spread to California and the continental US shortly after 2000. In 2007, the CDC recommended that fluoroquinolones should not be used as first-line therapy and recommended monitoring local resistance patterns to guide treatment recommendations. The Public Health-Dayton and Montgomery County STD Clinic tested N. gonorrhoeae isolates in 1996, 2001 and since 2006 to monitor susceptibility trends in the region. METHODS: Cultures for N. gonorrhoeae were collected from male and female patients presenting to the Public Health-Dayton and Montgomery County STD Clinic. In 1996 and 2001, consecutive isolate were collected. Since 2006, 10 isolates were randomly selected per month. Susceptibility testing was performed using Etest strips. Susceptibility results were interpreted following the Clinical Laboratory Standards Institute guidelines. RESULTS: In 1996, 102 isolates were tested; 85% were susceptible to ciprofloxacin (15% intermediate, 0% resistant) and 52% susceptible to tetracycline (39% intermediate, 9% resistant). In 2001, 106 isolates were tested; 100% were susceptible to ciprofloxacin and 76% susceptible to tetracycline (22% intermediate, 2% resistant). From 2006-2008, 286 isolates were tested; 98% were susceptible to ciprofloxacin (2% resistant), 60% susceptible to tetracycline (36% intermediate, 4% resistant) and 99% were susceptible to azithromycin. CONCLUSIONS: Rates of ciprofloxacin resistance remain low in Montgomery County. Azithromycin is another potentially useful treatment; tetracycline is not acceptable for empirical therapy.