Prosthesis choice in the adult USA population with partial edentulism.

OBJECTIVES: This study aimed to estimate the prevalence of prostheses and investigate how demographic and socioeconomic characteristics influence choices of restoration types in the adult population of the United States over 20 years of age. MATERIALS AND METHODS: The study utilized data from the National Health and Nutrition Examination Surveys (NHANES) conducted from 2017 to March 2020 Pre-Pandemic Data. We examined demographic and socioeconomic variables, dentition status, and restoration types among participants with partial edentulism. The percentage of categorical variables between restoration types was compared using chi-square tests. Multinomial logistic regression models were employed to explore the relationship between prosthetic choices and demographic and socioeconomic factors, both unadjusted and adjusted for all characteristics, including the number of missing teeth. RESULTS: Out of 15,560 participants, 7,805 eligible individuals with a mean age of 47.8 and a male percentage of 48.4% were included in the analysis. The results indicated that individuals who were younger, male, of Mexican American or non-Hispanic Black ethnicity, possessed lower educational attainment, were never married, had a low income-to-poverty ratio, held private insurance, or were unemployed were more inclined to choose no restoration. Further, males, non-Hispanic Black individuals, those with lower educational attainment, lower income-to-poverty ratios, and those who were unemployed or retired were more likely to choose RPDs over FPDs. Furthermore, never-married individuals and those with private insurance were likelier to choose FPDs in the maxilla (p < 0.01). CONCLUSIONS: Significant differences were observed among restoration types, demographic and socioeconomic variables, and dentition status in both the upper and lower jaws. CLINICAL RELEVANCE: This study underscores the significance of socioeconomic variables in the restoration of partial edentulism.

Prosthetic choice in mitral valve replacement for severe chronic ischemic mitral regurgitation: Long-term follow-up.

BACKGROUND: Prosthetic choice for mitral valve replacement is generally driven by patient age and patient and surgeon preference, and current guidelines do not discriminate between different etiologies of mitral valve disease. Our objective was to assess and compare short- and long-term outcomes after mitral valve replacement among patients with biological or mechanical prostheses in the setting of severe ischemic mitral regurgitation. METHODS: Between 2000 and 2016, 424 patients underwent mitral valve replacement for severe ischemic mitral regurgitation at our institution, using biological prosthesis in 188 (44%) and mechanical prosthesis in 236 (56%). A 1:1 propensity score match (n = 126 per group) and inverse probability of treatment weighting were used to compare groups. Short-term outcomes included in-hospital mortality and other cardiovascular adverse events. Long-term outcomes included survival and hospital readmission for cardiovascular causes, stroke, and major bleeding. RESULTS: In-hospital mortality and early postoperative adverse events were similar between groups in the propensity score match and inverse probability of treatment weighting cohorts. Overall long-term survival was similar at 5 and 9 years, but mechanical prosthesis recipients were more frequently readmitted to hospital for cardiovascular causes, including stroke and non-neurological bleeding in propensity score matching and inverse probability of treatment weighting analyses (all P values < .004). Type of prosthesis did not independently influence all-cause mortality (hazard ratio, 1.01; 95% confidence interval, 0.71-1.43; P = .959), but placement of a mechanical prosthesis was associated with increased risk of readmission for cardiovascular events (hazard ratio, 1.65; 95% confidence interval, 1.17-2.32; P = .004) among matched patients. CONCLUSIONS: The type of prosthesis has no influence on long-term survival among patients with severe ischemic mitral regurgitation undergoing mitral valve replacement. There may be an increased risk of neurologic events and serious bleeding associated with mechanical prostheses.

Surgeon's Preference in Total Knee Replacement: A Quantitative Examination of Attributes, Reasons for Alteration, and Barriers to Change.

BACKGROUND: The reasons why surgeons prefer a particular total knee replacement (TKR) to other viable options with lower cost or lower revision risk remain uncertain. This study examined the concept of surgeon's preference in TKR; including the self-assigned utility of their preferred prosthesis, reasons to alter usual preference and barriers to permanently changing preference. METHODS: Using a multinational electronic survey, 347 TKR performing orthopedic surgeons were studied using anonymous mandatory responses, mutually exclusive closed options, multiple responses blocking, automatic stem randomization, Likert scale weighting, and an absence of neutral options. RESULTS: The highest rated of the 17 attributes were "reproducibility of outcome," "best functional outcome," and "better kinematics." The lowest rated were a "key-opinion leader or mentor uses it" and "new or innovative." "Lowest revision risk" ranked 10th, with 19.9% of surgeons stating it did not influence their preference. Cost did not influence 52.1% of surgeons and 33.7% agreed that their institution or system limited their preference. Surgeon's demographics and preferred prosthesis or technique altered some attribute ratings including surgical volume, country of practice, type of preferred implant; however, revision risk rating was not altered by any factor. Cost considerations altered rating of barriers to technique change. CONCLUSION: Understanding why surgeons prefer certain TKR prostheses or techniques to other viable alternatives is vital to reduce unwarranted variation. This study suggests that the self-assigned reasons driving surgeon's preferences, reasons for preference alteration, and barriers to change are multifactorial, diverse, and complex, with revision risk not being the highest rated attribute.