Effects of preexisting depression and anxiety on postoperative outcomes following arthroscopic rotator cuff repair.

Background: Rotator cuff repairs (RCRs) are one of the most commonly performed shoulder surgeries in the United States. Psychological health has been shown to influence postoperative outcomes in orthopedic procedures. The purpose of this study is to evaluate the relationship between depression and anxiety (DA) and psychotropic medication and postoperative outcomes following RCR. Methods: A single institution retrospective observational cohort study of 816 patients undergoing arthroscopic RCR from January 2014 to October 2020 was conducted. Univariate statistics were used to assess differences in demographics, operative characteristics, and postoperative outcomes; multivariate analysis was used to evaluate risk factors for postoperative complications. Results: Patients with DA were more likely to have a higher first (3.60 vs. 3.00, P = .004) and last (1.23 vs. 0.96, P = .042) postoperative pain scores, lower first (18.67 vs. 21.85, P = .008) and last (61.87 vs. 64.71, P = .014) Upper Extremity Functional Score (UEFS), more likely to experience an emergency department visit postoperatively (9.1 vs. 5.0%, P = .028), have a symptomatic recurrent tear (8.2 vs. 3.3%, P = .003), and persistent pain (4.3 vs. 1.2%, P = .011). After controlling for age, sex, body mass index, American Society of Anesthesiologists score, diabetes, smoking, coronary artery disease, asthma, hypertension, psychotropic medication and DA, having DA at the time of surgery was independently predictive of any complication (odds ratio, 2.033; P = .028) and persistent pain (odds ratio, 8.232; P ≤ .001). Patients with and without DA showed significant improvement in postoperative pain and UEFS from the first to the last measurement (P < .001). Conclusion: DA is not a deterrent for RCR but targeted interventions may be needed to decrease the occurrence of complications.

Mid-term outcomes of anterior cruciate ligament reconstruction across age groups: A national database study.

BACKGROUND: The purpose of this study was to examine the impact of age on complication risk after anterior cruciate ligament reconstruction. METHODS: The TriNetX research database was retrospectively queried for patients undergoing primary arthroscopic ACL reconstruction. Univariate logistic regression was performed to evaluate the risk of complication by age group. RESULTS: A total of 21,449 patients were included in the study. Patients ≥61 years old demonstrated significantly higher rates of repeat reconstruction. Rates of postoperative opioid related disorders and surgical site infection varied by age. CONCLUSION: For patients undergoing ACL reconstruction, increasing age is associated with increased risk of developing opioid related disorders, and repeat reconstruction.

Early postoperative pain and opioid consumption after arthroscopic shoulder surgery with or without open subpectoral biceps tenodesis and interscalene block.

OBJECTIVE: The addition of open subpectoral biceps tenodesis to arthroscopic shoulder surgery with interscalene block has been anecdotally observed to result in increased postoperative pain. This study aims to evaluate the impact of tenodesis on early postoperative pain and recovery. METHODS: A retrospective review of patients undergoing arthroscopic shoulder surgery with general anesthesia and interscalene block was conducted. RESULTS: Patients undergoing tenodesis experienced longer OR time, pain numeric rating scale (NRS), and consumed more morphine milligram equivalents (MME) in PACU. After controlling for confounding factors, tenodesis was significantly associated with increased opioid MME consumption in the PACU (ß = 1.045, p = .028) and last PACU pain NRS (ß = 0.541, p = .009). CONCLUSION: Overall, pain scores and narcotic consumption were low after surgery, making these differences potentially clinically insignificant. Further study is required to evaluate whether these trends are consistent among this population.

Precision analysis of a quantitative CT liver surface nodularity score.

PURPOSE: To evaluate precision of a software-based liver surface nodularity (LSN) score derived from CT images. METHODS: An anthropomorphic CT phantom was constructed with simulated liver containing smooth and nodular segments at the surface and simulated visceral and subcutaneous fat components. The phantom was scanned multiple times on a single CT scanner with adjustment of image acquisition and reconstruction parameters (N = 34) and on 22 different CT scanners from 4 manufacturers at 12 imaging centers. LSN scores were obtained using a software-based method. Repeatability and reproducibility were evaluated by intraclass correlation (ICC) and coefficient of variation. Using abdominal CT images from 68 patients with various stages of chronic liver disease, inter-observer agreement and test-retest repeatability among 12 readers assessing LSN by software- vs. visual-based scoring methods were evaluated by ICC. RESULTS: There was excellent repeatability of LSN scores (ICC:0.79-0.99) using the CT phantom and routine image acquisition and reconstruction parameters (kVp 100-140, mA 200-400, and auto-mA, section thickness 1.25-5.0 mm, field of view 35-50 cm, and smooth or standard kernels). There was excellent reproducibility (smooth ICC: 0.97; 95% CI 0.95, 0.99; CV: 7%; nodular ICC: 0.94; 95% CI 0.89, 0.97; CV: 8%) for LSN scores derived from CT images from 22 different scanners. Inter-observer agreement for the software-based LSN scoring method was excellent (ICC: 0.84; 95% CI 0.79, 0.88; CV: 28%) vs. good for the visual-based method (ICC: 0.61; 95% CI 0.51, 0.69; CV: 43%). Test-retest repeatability for the software-based LSN scoring method was excellent (ICC: 0.82; 95% CI 0.79, 0.84; CV: 12%). CONCLUSION: The software-based LSN score is a quantitative CT imaging biomarker with excellent repeatability, reproducibility, inter-observer agreement, and test-retest repeatability.

Regulation of alcohol intake with advancing age.

Previous surveys of alcohol use in the general population have not gathered sufficient data to allow for estimations of the blood alcohol levels (BACs) routinely achieved in survey participants. Our goal was to assess the influence of age on the estimated peak BAC achieved on typical drinking occasions in a representative sample (n=2,626) of the U.S. adult population. Variables related to the quantity and duration of alcohol consumption on typical drinking occasions were assessed by computer-assisted telephone interview. In addition, the height, weight, age, and gender of subjects were ascertained to be used in equations to predict the volume of distribution of ethanol (total body water). Prediction equations were used to estimate the probable peak BACs achieved during the typical drinking occasion. The survey identified 1,833 subjects ("current drinkers") of 18-89 years, who reported alcohol consumption within the past 12 months. Linear regression analyses performed on data from these "current drinkers" revealed that, for both men and women, there was an age-related decrease in the predicted peak BAC achieved on typical drinking occasions. The approaches used to modify the BAC with advancing age differed slightly for men and women, but both relied heavily upon a reduction in the quantity of consumption.

Gender comparison of alcohol exposure on drinking occasions.

OBJECTIVE: This study was designed to assess the influence of gender, age, drinking style and other selected demographic variables on the rate of alcohol beverage consumption on drinking days. The data were used to predict possible differences in ethanol exposure levels (peak blood alcohol concentration [BAC]) among the subgroups examined. METHOD: A representative sample (N = 2,627) of the U.S. adult population was surveyed using computer-assisted telephone interviewing to assess alcohol use (past 12 months) in quantity, frequency and type of beverage, as well as the time (minutes) usually required to consume the typical quantity of alcohol on drinking days. RESULTS: Of the 1,833 current drinkers (1,028 men, 805 women), women reported consuming a mean of 2.2 standard drinks (1 drink = 12 g ethanol) on typical drinking occasions (days); men reported consuming a mean of 3.2. The duration of the drinking episode was similar for women (122 minutes) and men (126 minutes). The hourly rate of drink consumption was thus lower for women (approximately 1.1 drinks/hour) than for men (approximately 1.6 drinks/hour). For both men and women, there was an age-related increase in the frequency of drinking but a decrease with age in predicted peak BACs and in the alcohol intake per drinking episode. Peak BACs achieved during typical drinking episodes were estimated to be quite similar for men (0.037) and for women (0.036) when prediction equations were based on equal rates of alcohol elimination in both genders. The estimated peak BACs were lower in women than in men when the prediction equation assumed a higher rate of ethanol elimination in women. CONCLUSIONS: Information on the rate of alcohol beverage consumption on drinking days facilitates prediction of BACs typically experienced in men and women of different demographic group memberships. The exposure values obtained will depend upon as yet unsettled norms for ethanol elimination rates in men and women.

Uniqueness and nonuniqueness in the Einstein constraints.

The conformal thin-sandwich (CTS) equations are a set of four of the Einstein equations, which generalize the Laplace-Poisson equation of Newton's theory. We examine numerically solutions of the CTS equations describing perturbed Minkowski space, and find only one solution. However, we find two distinct solutions, one even containing a black hole, when the lapse is determined by a fifth elliptic equation through specification of the mean curvature. While the relationship of the two systems and their solutions is a fundamental property of general relativity, this fairly simple example of an elliptic system with nonunique solutions is also of broader interest.

Association of age at first drink with current alcohol drinking variables in a national general population sample.

BACKGROUND: Age at first drink has been found to be associated with alcohol problems in adulthood, but little is known regarding the relationship of age at first drink and current alcohol intake variables. This study was designed to determine the relationship of age at first drink to traditional drinking variables as well as novel current drinking variables assessed for the first time in a national general population sample. METHOD: Data on age of first drink, pathological drinking (DSM-IV alcohol abuse or dependence) and alcohol intake on typical drinking occasions were collected on a national general population sample of 2631 subjects by means of computerized telephone interviewing. Variables assessed for the first time in a national survey included the duration of the typical drinking episode and the predicted peak blood alcohol levels achieved during those episodes. RESULTS: Data from 2276 subjects who reported an age at first drink were used in this study. Men and lifetime pathological drinkers reported an earlier age at first drink than did, respectively, women or lifetime nonpathological drinkers. There were significant regression coefficients between age at first drink and several current drinking measures. The largest coefficients were usually found within younger age groups. CONCLUSIONS: Age at first drink may be a useful predictive variable for some current drinking measures, including predicted peak blood alcohol levels as well as lifetime alcohol pathology. Further support was provided for the "convergence" hypothesis that the drinking habits of women have become more like those of men.