The Implications of Socioeconomic Status by ZIP Code on Maternal-Fetal Morbidity and Mortality in San Antonio, Texas.

Introduction Over the past 20 years, the number of pregnancy-related fatalities in the United States has been on the rise. Increases in maternal and fetal mortality have been attributed to low socioeconomic status (SES). This raises the question of whether all geographical locations are proportionally affected by this upward trend in pregnancy-related fatalities. San Antonio is one of the largest cities in the United States and is known for its economic segregation. This study aims to compare the maternal and fetal health outcomes of mothers from diverse socioeconomic backgrounds in San Antonio, Texas. Methods To analyze the relationship between pregnancy-related mortality rates and SES in San Antonio, Texas, the International Classification of Diseases (ICD)-10 codes for maternal and fetal demise and their associated risk factors were identified. The ICD-10 codes were used to compare the health outcomes of pregnant women from the highest SES ZIP Code (78255, median income $124,397) to women from the lowest SES ZIP Code (78207, median income $25,415) using the Texas Inpatient Public Use Data File for 2016, which contains information on 93-97% of all hospital discharges in San Antonio, Texas. Results Notably, pregnant women from the high SES ZIP Code were admitted to the hospital from clinics or a physician's office (68.8%), while pregnant women from the low SES ZIP Code were admitted to the hospital from non-healthcare facilities like home or workplace (62.5%). In addition, a greater percentage of patients from the low SES ZIP Code were Black (4.3% vs 1.3%) or Hispanic (88.5% vs 35.1%). Compared to women from the high SES ZIP Code, women from the low SES ZIP Code experienced more fetal deaths and a higher prevalence of maternal and fetal risk factors such as obesity (47.6% vs 32.5%), asthma (1.7% vs 1.3%), hypertension (0.8% vs 0%), substance abuse (0.5% vs 0%), diabetes mellitus (9.8% vs 7.8%), preeclampsia (7.7% vs 2.6%), and multiple C-sections (35.5% vs 28.6%). Finally, fetal mortality rates were higher in the low SES ZIP Code (1.1% vs 0%). Although there were no statistically significant maternal or fetal mortality differences between the ZIP Codes, the trend suggests that women's health outcomes in San Antonio are not equitable. Discussion Analysis reveals disproportionate health outcomes for women in south San Antonio. Further investigation is warranted to better understand the role social and medical factors play in these results. Investigating the relationship between SES and pregnancy-related mortality can help to better inform healthcare providers and identify ways to improve women's health outcomes in San Antonio, Texas.

Top 50 most impactful publications on massive rotator cuff tears.

Background: Bibliometric analysis is a useful tool for measuring the scholarly impact of a topic and its more and less heavily studied aspects. The purpose of this study is to use bibliometric analysis to comprehensively analyze the 50 articles with the highest citation indices in studies evaluating the treatment and outcomes of massive rotator cuff tears (mRCTs). Methods: This cross-sectional study identified articles within the Scopus database published through December 2022. Keywords used were "massive rotator cuff tear." Articles were sorted in chronological order. The year published and number of citations were recorded. A citation index (CI) was calculated for each article by dividing the number of citations by number of years published [1 citation/1 year published (2021) = CI of 1]. Of these, the 50 articles with the highest CIs were carried forward for evaluation. Frequencies and distributions were assessed for data of each variable collected. Results: These search methods produced 625 articles regarding mRCT research (ranging from January 1986 to December 2022). Four of the top 10 most impactful articles were published in the 2010s. The level of evidence (LOE) published with the greatest frequency was level of evidence 4 (41%). The journal Arthroscopy published the highest number within the top 50 (26%) followed by the Journal of Bone and Joint Surgery and the American Journal of Sports Medicine (20% each). Clinical studies composed 88% of the top 50. Case series (38%) predominated, while systematic reviews (20%) and randomized control trials (8%) were less prevalent. The majority of studies concentrated on the clinical outcomes of certain interventions (62%), mainly comparing multiple interventions. Conclusion: Despite the relatively high prevalence of mRCTs (40% of all tears), this topic comprises only a small proportion of all rotator cuff research. This analysis has identified gaps within and limitations of the findings concerning mRCTs for researchers to propose research questions targeting understudied topics and influence the future treatment and outcomes of this clinically difficult diagnosis.

A 25-Year Analysis of Diversity, Equity, and Inclusion Research in Orthopaedics Shows Majority Female Authorship and Increasing Gender Parity Research.

Introduction: Orthopaedic surgery is one of the least diverse fields in medicine. In recent decades, there has been a concerted effort to increase diversity, equity, and inclusion (DEI) in the specialty, in addition to the institution of several organizations to establish the pipeline and facilitate underrepresented minority students into orthopaedic surgery. The aim of this study was to examine trends in orthopaedic surgery DEI research. Methods: A search of DEI articles was conducted in orthopaedic surgery using PubMed, MEDLINE, EMBASE, Scopus, Cumulative Index to Nursing and Allied Health Literature, and Education Resources Information Center. The year of publication, article topic of focus, sex of the primary author, publishing journal, citation index, and primary contributing institution were recorded for each article. Sex of the primary author was predicted by the authors using an online image search of the author and institution. Articles were excluded if the research was conducted outside of the United States or if they were not specific to orthopaedic surgery. Results: A total of 143 articles met the inclusion criteria. A total of 52.4% of authors (n = 75) were women and 44.1% (n = 63) were men. A total of 42.7% of the articles were written about sex (n = 61), 39.9% about race/ethnicity and sex (n = 57), and 11.9% about race/ethnicity (n = 17). A total of 10 articles were affiliated with Washington University in St. Louis while 51 other institutions wrote the remaining articles, with none having more than 4. Information could not be confirmed for 5 articles. In 2018, 5 articles were published, followed by 17 in 2019, 25 in 2020, 34 in 2021, and 30 in 2022. Conclusion: DEI research in orthopaedic surgery is a relatively new venture within the specialty and has room to grow, specifically in the examination of race/ethnicity and inclusion strategies. Leading journals and academic institutions in orthopaedic surgery should incentivize productivity and authorship in DEI research. Level of Evidence: III.

Education Research in Orthopaedic Surgery: A 6-Year Analysis.

With the ever-changing dynamics of surgical training, it is essential for the content of educational research to evolve simultaneously. This study aimed to assess the current state of scholarly work in orthopaedic training education and to identify particular educational topics that are trending in the literature. Methods: A PubMed search string was used to identify literature on orthopaedic surgery education from 2016 to 2021. Publications on orthopaedic surgery education were divided into 8 education-based categories: (1) operative training and simulation, (2) curriculum and career development, (3) diversity, (4) wellness and burnout, (5) program evaluation and match data, (6) trainee assessments, (7) social media, and (8) other. Univariate analysis and linear regression were used to determine trends. Results: A total of 383 orthopaedic surgery education publications met inclusion criteria. Orthopaedic surgery education publications accounted for 0.47% of the total publications from all 54 journals. Fifteen journals provided 85% of all orthopaedic education publications (N = 325). The Journal of Bone and Joint Surgery produced the most orthopaedic surgery education publications (76, 20%), followed by the Journal of Surgical Education (62, 16%) and the Journal of the American Academy of Orthopaedic Surgeons (58, 15%). Publications on curriculum and career development were the most common (21.9%). The following most frequent topics were program evaluation and match data (20.9%) and operative training and simulation (18%), respectively. Over the study period, the total amount of orthopaedic surgery education articles increased significantly (R2 = 0.86, p = 0.008). Articles included all levels of training, with resident education accounting for the majority, with 269 articles (70.2%). Conclusion: Recent trends in orthopaedic literature indicate an increased emphasis on education as the number of publications has increased, but are still sparse in orthopaedic literature. As the field of orthopaedics continues to advance, we recommend that academic institutions and organizations continue to evaluate and promote evidence-based educational research to ensure that orthopaedic education meets the ever-increasing demands that residents and practicing surgeons will face in the present and future. Level of Evidence: III.

Disparities in Ocular and Periocular Cancer Outcomes: Assessing Survival in Patients of Hispanic Origin.

A nationwide cancer database was used to perform a retrospective cohort study to compare the overall survival and cause-specific survival in patients with ocular and periocular cancer from varying Hispanic origins. A total of 19,831 cases from the Surveillance, Epidemiology, and End Results (SEER) registries between 1973 and 2015 were obtained for analysis. All-cause and cause-specific mortality risk, with adjustment for age group, sex, race, tumor site, tumor histology, grade, summary stage, laterality, surgery status, radiotherapy status, and chemotherapy status, was examined using Cox proportional hazard models. Of the patients included 19,194 patients were non-Spanish-Hispanic-Latino, and 637 patients were Spanish-Hispanic Latino. The Spanish-Hispanic-Latino population was further subdivided as 398 of Mexican origin, 44 of Puerto Rican origin, 135 of South or Central American (excluding Brazil) origin, and 60 of other Spanish/Hispanic origin (including Europe origin). The mean (+/-SD) follow-up period was 98.57 (+/-93.23) months. In adjusted Cox regression, patients of Spanish-Hispanic-Latino origin demonstrated increased all-cause (HR, 1.173; 95% CI 1.022-1.347; P = 0.023) and cancer-specific mortality (HR, 1.328; 95% CI 1.099-1.604; P = 0.003) as compared to their non-Spanish-Hispanic-Latino counterparts. Upon subclassification by Hispanic origin, patients of Mexican origin had significantly increased all-cause (HR, 1.229; 95% CI 1.032-1.464; P = 0.021) and cancer-specific mortality (HR, 1.516; 95% CI 1.204-1.909; P < .001) and patients with other Hispanic/Spanish origin, including Europe, had significantly increased all-cause (HR, 1.627; 95% CI 1.16-2.28; P =0.005), but not cancer-specific (HR, 1.243; 95% CI 0.734-2.104; P = 0.418) mortality. Patients of Puerto Rican origin and South or Central American (excluding Brazil) origin had no significant difference in all-cause or cancer-specific mortality compared to those of non-Spanish-Hispanic-Latino origin. Mortality risk from ocular and periocular cancers varies extensively by specific Hispanic origin. A greater understanding of these disparities is essential to identify vulnerable populations and provide adequate treatment to optimize long-term outcomes.