Nonoperative Management of Olecranon Fractures in Elderly Patients: A Systematic Review.

BACKGROUND: Despite increased utilization of conservative measures for displaced olecranon fractures in elderly patients, in whom operative fixation may be complicated by coexisting comorbidities and declining bone quality, the noninferiority of nonoperative management has yet to be proven. The purpose of this study was to review nonoperative management of displaced olecranon fractures in the elderly patient population. METHODS: A literature search of the PubMed database was performed using the term olecranon fracture. Papers included those with results for patients aged 65 years and older published between 1990 and 2018 in the English language. Data were pooled to analyze outcomes and complications of nonoperative management of olecranon fractures in the elderly patient population. RESULTS: Four eligible studies combined for a total of 69 patients with 70 fractures with an average age of 83.8 years (71-95 years), female predominance of 88%, and a mean follow-up of 12.4 months who underwent nonoperative management of displaced olecranon fractures. While only 25% of fractures went on to radiographic union, the mean Disabilities of the Arm, Shoulder, and Hand score was 16.9 (0-59.6), the mean arc of motion was 138°, and 92% of patients achieved excellent results. One-quarter (26%) of the patients experienced complications: radial head subluxation (1), skin sore (1), degenerative arthropathy (1), pain on movement (2), click in movement of the elbow (5), and local pain (8). CONCLUSION: Displaced olecranon fractures in patients aged older than 70 years may be effectively managed with nonoperative measures to produce high satisfaction and functional range of motion.

The MBSAQIP is going viral! 194 hits and still going strong.

BACKGROUND: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) first released its Participant Use Data File in 2015. Since then, surgeons have eagerly evaluated data now available on >750,000 patients, and a yearly increase in the number of publications using the Participant Use File was anticipated. OBJECTIVE: To evaluate the impact of the MBSAQIP in surgical literature. SETTING: University surgical department, United States. METHODS: A literature search was performed to identify articles published using the MBSAQIP database up to March 2019. PubMed, Clinical Key (both indexed for MEDLINE), and Cochrane databases were queried using the keywords "MBSAQIP" and "Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program." Abstracts presented at ObesityWeek, SAGES, and the Clinical Congress of the ACS in 2016 to 2019 were also examined. Duplicates, letters to the editor, commentaries, statements, and position pieces were excluded. Articles describing projects that used MBSAQIP data to study <5 accredited centers were also excluded. RESULTS: As of March 2019, there were 114 results in PubMed, 216 results in Clinical Key, and 0 in Cochrane using the search terms. Additionally, 184 abstracts were included from the journal supplements from ObesityWeek, SAGES, and the Clinical Congress of the ACS. After elimination of duplicates, there were 327 total results. After exclusions, 55 published manuscripts and 126 abstracts remained. CONCLUSION: The MBSAQIP is a resounding success. A substantial body of research has already been produced from it and is growing with time. Gaps in current knowledge are being targeted through analyses of this single, large-scale database. The MBSAQIP will remain a valuable leading resource in metabolic and bariatric surgery.

How many sleeve gastrectomies are done at nonaccredited centers in Texas?

BACKGROUND: The American College of Surgeons created the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) to improve the safety of surgery and track outcomes of patients undergoing metabolic and bariatric surgery. The MBSAQIP captures all surgical procedures performed at accredited centers (AC) but not all metabolic and bariatric surgery cases performed in the United States. Texas has a large statewide administrative database that tracks nearly all surgical procedures performed in the state and we proposed using this database to assess the number of sleeve gastrectomies (SG) and whether they were performed at an AC or not. OBJECTIVE: Our objective was to determine the percentage of SG that are performed in MBSAQIP ACs. SETTING: University surgical department, United States. METHODS: The Texas Inpatient and Outpatient Public Use Data Files (PUDF) for the year 2017 were examined. We used the Current Procedural Terminology and International Classification of Diseases version 10 codes for SG, 43775 and 0 DB64 Z3, respectively. We compared the PUDF facility list to a list of MBSAQIP ACs in Texas. RESULTS: There were 4549 SG performed in Texas in 2017 reported in the Outpatient PUDF. Of these, 80.8% of cases were performed at ACs. Of the 136 facilities in the outpatient PUDF performing SG, 58 were MBSAQIP accredited. In the Inpatient PUDF for 2017 there were 11,287 SG, of which 9829 (87%) were performed at ACs. Of 153 centers performing SG, 77 were MBSAQIP accredited. There was a higher percentage of adjustable band conversions to SG at non-ACs in the Outpatient PUDF than the Inpatient PUDF. CONCLUSION: The MBSAQIP database is missing almost 20% of outpatient SG performed in Texas and 13% of inpatient SG. Administrative databases can be used to externally validate the MBSAQIP.