Outcome and cost analysis of primary total knee arthroplasty in end-stage renal disease patients: A nationwide population-based study.

BACKGROUND: A number of patients with end-stage renal disease (ESRD) undergo total knee arthroplasty (TKA) due to advanced knee joint osteoarthritis. There are few studies describing the incidence, morbidities, mortality rate, and cost analysis regarding ESRD patients receiving TKA. METHODS: We retrospectively retrieved patient data from National Health Insurance Research Database in Taiwan during 2005-2011, and evaluated the outcomes of TKA in patients with (ESRD group) and without ESRD (non-ESRD group). Patients' demographic data, comorbidities, mortality, and in-hospital cost were recorded. RESULTS: A total of 578 TKAs and 110,895 TKAs were identified in the ESRD and non-ESRD group, respectively. The incidence of patients receiving TKA was higher in the ESRD than in non-ESRD group by at least 2 folds. The ESRD group showed significantly more medical complications (pneumonia, peptic ulcer disease, and acute myocardial infarction) after surgery. In prosthesis-related complications, the ESRD group also had more periprosthetic joint infections, and prosthetic loosenings by one year. The one-year mortality rate was more than 6 times higher in the ESRD than in the non-ESRD group. The ESRD group had higher in-hospital medical expense than the non-ESRD group, especially when there were complications, even when the dialysis-related costs were exempted. CONCLUSION: The complication rate, mortality rate, and cost were higher in the ESRD patients receiving TKA. When considering TKA in ESRD patients, it is crucial to weigh the risks against benefits of TKA, and have a thorough discussion with the patients.

Incidence of second hip fractures and associated mortality in Taiwan: A nationwide population-based study of 95,484 patients during 2006-2010.

OBJECTIVES: The aim of the study is was to determine the incidence and mortality of second hip fracture using a nationwide database. PATIENTS AND METHODS: A nationwide epidemiological study was conducted using the Taiwan National Health Insurance Research Database from 2001 to 2011. Patients older than 50 years with hip fractures from 2006 to 2011 were included in the study. A total of 95,484 hip fractures were identified, with subsequent second hip fracture occurred in 4102 of them. RESULTS: The incidence rate ratio of second hip fracture showed a 7.13 fold of risk of further hip fracture in 3 months, 5.21 fold in one year, and remained more than 2 fold in the end of 6th year when compared with the general population. The 6-year cumulative incidence of a second hip fracture was higher in female (8.0%) than in male (6.2%). A significantly higher 1-year mortality rate was seen after a second hip fracture (18.8%) compared to the first hip fracture (14.1%) (p < 0.05). Men had higher 1- and 5-year mortality rates after second hip fractures (12.1% and 41.2%, respectively) than women (17.4% and 47.3%, respectively). CONCLUSIONS: Patients with hip fractures would have a 2-7 fold of risk of a second fracture within 6 years. Women were more prone to a second hip fracture than men but men had a higher mortality rate.

The relationships among nurses' job characteristics and attitudes toward web-based continuing learning.

The purpose of this study was to explore the relationships between job characteristics (job demands, job control and social support) and nurses' attitudes toward web-based continuing learning. A total of 221 in-service nurses from hospitals in Taiwan were surveyed. The Attitudes toward Web-based Continuing Learning Survey (AWCL) was employed as the outcome variables, and the Chinese version Job Characteristic Questionnaire (C-JCQ) was administered to assess the predictors for explaining the nurses' attitudes toward web-based continuing learning. To examine the relationships among these variables, hierarchical regression was conducted. The results of the regression analysis revealed that job control and social support positively associated with nurses' attitudes toward web-based continuing learning. However, the relationship of job demands to such learning was not significant. Moreover, a significant demands×job control interaction was found, but the job demands×social support interaction had no significant relationships with attitudes toward web-based continuing learning.

Computed tomography-based navigation-assisted pedicle screw insertion for thoracic and lumbar spine fractures.

BACKGROUND: Incorrect placement of pedicle screws may lead to neurovascular injury, so the position is important for the reduction of spinal fractures. CT-based image-guided surgery has been promoted as a means to theoretically improve the accuracy of pedicle screw placement. Patients who underwent CT-based navigation-assisted pedicle screw fixation for thoracic or lumbar fractures were reviewed to evaluate the accuracy of pedicle screw placement for spinal fracture cases. METHODS: A computed tomographic (CT)-based image-guided system (BrainLAB) was used for pedicle screw insertion in 14 patients with thoracic or lumbar spine fractures. The accuracy of pedicle screw placement was analyzed by the preoperative and postoperative Cobb's angle and sagittal screw angle with a review of radiographic images, and the penetration of the pedicle cortex by postoperative CT scans. RESULTS: Under the guidance of CT-based navigation 102 screws were inserted. Cobb's angle was corrected to an average of 15 degrees in the 14 patients. The sagittal screw angle was less than 10 degrees for 92 (90.2 %) screws, and the overall average was 5 degrees. The results of the postoperative CT review showed only 3 (2.9 %) screws penetrated the pedicle cortex laterally and no screw penetrated medially. No iagtrogenic neurological injury was found. CONCLUSION: The accuracy of pedicle screw placement is crucial for thoracolumbar spine fracture fixation. The placement of pedicle screws can be done accurately with the aid of a CT-based image-guided system. Furthermore, this opens the possibility for surgeons to reduce radiation exposure by eliminating the need for intraoperative fluoroscopy.