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1.
J Arthroplasty ; 34(11): 2632-2636, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31262621

RESUMO

BACKGROUND: It is important to study the incidence and causes of readmissions in order to understand why they occur and how to reduce them. This study looks at a national sample of patients following total knee arthroplasty (TKA) to identify incidences, trends, causes, and timing of 30-day readmissions. METHODS: Patients undergoing primary TKA from 2012 to 2016 in the American College of Surgeons National Surgical Quality Improvement Program database were identified (n = 197,192). Patients with fractures (n = 177), nonelective surgery (n = 2234), bilateral TKA (n = 5483), and cases with unknown readmission status (n = 1047) were excluded, leaving a total of 188,251 cases. Linear regression analysis was used to determine trends over time. RESULTS: The incidence of overall 30-day readmission following primary TKA from 2012 to 2016 was 3.19% (6014/188,251), with significant decreases in readmission rates during this time (ß = -0.001, P < .001). The top 5 causes of readmission included superficial surgical site infection (SSI; 9.7%), non-SSI infection (9.5%), cardiovascular complications (CV; 9.3%), gastrointestinal complications (8.8%), and venous thromboembolisms (8.8%). The most common cause of readmission during postoperative week 1 was CV complications (12.2%), week 2 was superficial SSI (11.6%), week 3 was deep SSI (11.4%), and week 4 was deep SSI (12.4%). CONCLUSION: Overall, 30-day readmissions following TKA were found to significantly decline from 2012 to 2016. The most common causes of overall readmission included superficial SSI, non-SSI infection, CV complications, gastrointestinal complications, and venous thromboembolisms. However, the most common causes of readmission changed from week to week postoperatively. This data may help institutions develop policies to prevent unplanned readmissions following TKA.


Assuntos
Artroplastia do Joelho , Readmissão do Paciente , Artroplastia do Joelho/efeitos adversos , Humanos , Incidência , Complicações Pós-Operatórias/epidemiologia , Fatores de Risco
2.
J Arthroplasty ; 33(7S): S219-S223, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29352690

RESUMO

BACKGROUND: Surgeons often rely on intra-operative histology (frozen sections [FS]) to determine the next step in surgical management during the second stage (re-implantation surgery) of 2-stage revision arthroplasty. The purpose of the study is to assess the accuracy of permanent sections (PS) and FS in the diagnosis of persistent infection during re-implantation in patients with an inflammatory arthritis. METHODS: From 2001 to 2016, 47 planned second-stage revision total hip arthroplasty and total knee arthroplasty in patients with inflammatory arthritis were identified. Revisions were classified as having persistent infection if they were Musculoskeletal Infection Society positive at the time of second stage. PS or FS was considered to be positive for infection when at least one of the specimens demonstrated an acute inflammation. Receiver operating characteristic analysis was performed to obtain the diagnostic parameters. RESULTS: There were 9 (19%) persistent infections. Both PS and FS had very high specificity (PS = FS = 94.7%). Sensitivity of PS was higher than FS, although not statistically significant (PS = 88.9%, FS = 55.6%, P = .083). Overall, PS had a better diagnostic utility than FS (area under the curve: PS vs FS = 0.92 vs 0.75, P = .045). Four specimens had discrepancies between PS and FS histology. In all 4 instances, the specimens were read as positive (infected) by PS, but negative by FS. CONCLUSION: Histological analysis is recommended at the time of re-implantation surgery even in patients with inflammatory arthritis. PS had a better diagnostic utility than FS suggesting that areas of acute inflammation may be scattered and may not always be captured in the specimens taken for FS.


Assuntos
Artrite Infecciosa/patologia , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Articulações/patologia , Infecções Relacionadas à Prótese/patologia , Idoso , Artrite Infecciosa/etiologia , Artrite Infecciosa/cirurgia , Feminino , Secções Congeladas , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Sensibilidade e Especificidade
3.
J Arthroplasty ; 33(7S): S196-S200, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29273292

RESUMO

BACKGROUND: Airborne bacteria are a major source for wound contamination during total joint arthroplasty. Crystalline ultraviolet C (C-UVC) filter units were designed to disinfect and recirculate air in the operating room (OR). This preliminary study assessed the particle reducing capacity of C-UVC units in a highly controlled OR setting. METHODS: A particle counter was deployed in a positive-pressure OR to measure total and viable particle counts (TPC/VPC). Thirty 23-minute experiments were performed. At 4 designated times a person would walk through the door to mimic OR traffic. Ten experiments were performed as controls, 10 experiments used a C-UVC unit 4 meters (m) from the door, and 10 cases with the C-UVC unit at 8 m. Outcomes included overall, change (Δ), and maximum TPC/VPC. Mann-Whitney U-tests determined statistical differences in TPC/VPC. RESULTS: Compared to controls, the cases with the C-UVC unit at 4 m had significantly lower particle levels. Overall TPC/VPC, changes in TPC/VCP, and maximum TPC/VPC were all significantly lower (P < .05) in the C-UVC unit (4 m) group compared to the controls. The C-UVC at 8 m significantly reduced TPC in all 3 outcomes (P < .05) compared to controls; however, it did not significantly reduce changes in VPC (P = .107) and maximum VPC (P = .052). There were no significant differences in any outcomes between the 4 m and 8 m group. CONCLUSION: C-UVC units have shown to be capable of significantly reducing TPC and VPC in a highly controlled OR setting. Reducing airborne particles using C-UVC units may reduce infection rates following total joint arthroplasty.


Assuntos
Desinfetantes , Desinfecção/métodos , Salas Cirúrgicas , Raios Ultravioleta , Poluentes Atmosféricos , Poluição do Ar em Ambientes Fechados/prevenção & controle , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Bactérias , Desenho de Equipamento , Humanos , Projetos Piloto , Resultado do Tratamento
4.
Surg Technol Int ; 30: 415-424, 2017 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-28696494

RESUMO

Pain, swelling, and inflammation of the knee joint and its surrounding soft-tissue structures are common during the postoperative period after arthroscopic knee debridement and anterior cruciate ligament reconstruction. These challenges can make patient recovery difficult immediately after surgery. Several options exist, however, to help patients overcome these challenges. Cryotherapy has been noted to decrease pain, swelling, and inflammation. However, while a number of studies exist characterizing the use of cryotherapy after knee surgery, no definitive cryotherapy devices and modalities have been identified. Therefore, the purpose of this review was to evaluate randomized controlled trials to assess the use of cryotherapy after: 1) arthroscopic debridement; and 2) anterior cruciate ligament reconstruction.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Artroscopia , Crioterapia , Desbridamento , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Reconstrução do Ligamento Cruzado Anterior/estatística & dados numéricos , Artroscopia/efeitos adversos , Crioterapia/estatística & dados numéricos , Desbridamento/efeitos adversos , Desbridamento/estatística & dados numéricos , Humanos , Traumatismos do Joelho/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto
5.
Surg Technol Int ; 31: 322-326, 2017 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-29316589

RESUMO

INTRODUCTION: To determine the effort required to provide a service, the United States Medicare uses Relative Value Units (RVUs). Consequently, higher RVUs are assigned to the procedures or services that require more effort, which ultimately means the physician will be properly compensated for the additional effort required. In total ankle arthroplasty (TAA), revision cases usually are more technically challenging and require more effort than primary TAA. Therefore, the purpose of this study was to compare the: 1) RVUs; 2) length-of-surgery; 3) RVU per unit of time between primary and revision total ankle arthroplasty; and 4) the individualized idealized surgeon annual cost difference analysis. MATERIALS AND METHODS: We utilized the American College of Surgeons, National Surgical Quality Improvement Program database from 2008 to 2015 to identify patients who underwent either a primary Current Procedural Terminology [CPT]: 27702) or revision (CPT: 27703) TAA. There were a total of 653 patients, 586 of which underwent a primary, and 67 who underwent a revision, TAA. The mean RVUs, length of surgery (in minutes), and RVU per minute, were calculated. Dollar amount per minute, per case, per day, and per year, to find an individualized idealized surgeon annual cost difference, were also calculated. An analysis of variance was used to compare variables between primary and revision TAA. A p-value of less than 0.05 was used to determine statistical significance. RESULTS: The mean RVU was significantly higher in revision versus primary TAA (16.93 vs. 14.41, p=0.001). However, there was no significant difference in the mean lengths of surgery between primary and revision TAA (160 vs. 157 minutes, p=0.613). Additionally, the mean RVU per minute was significantly higher in revision versus primary TAA (0.13 vs. 0.10, p=0.001). CONCLUSION: Based on the results of this study, it appears that revision TAA cases are appropriately assigned a higher RVU per minute for performing them as they require more effort and are more challenging compared to the primary TAA. Furthermore, not only did the revision cases have lower mean lengths of surgery, but they also maintained a higher RVU per minute. Therefore, orthopaedists can use this information to further help them yield the best potential practice design.


Assuntos
Artroplastia de Substituição do Tornozelo/economia , Artroplastia de Substituição do Tornozelo/estatística & dados numéricos , Escalas de Valor Relativo , Reoperação/economia , Reoperação/estatística & dados numéricos , Análise de Variância , Feminino , Humanos , Masculino , Duração da Cirurgia , Estudos Retrospectivos
6.
J Med Case Rep ; 6: 93, 2012 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-22472269

RESUMO

INTRODUCTION: Thrombotic thrombocytopenic purpura and idiopathic thrombocytopenic purpura are two well recognized syndromes that are characterized by low platelet counts. In contrast, essential thrombocythemia is a myeloproliferative disease characterized by abnormally high platelet numbers.The coexistence of thrombotic thrombocytopenic purpura and idiopathic thrombocytopenic purpura in a single patient has been reported in the literature on a few occasions. However, having essential thrombocythemia complicating the picture has never been reported before. CASE PRESENTATION: We present a case where thrombotic thrombocytopenic purpura, essential thrombocythemia, and idiopathic thrombocytopenic purpura were diagnosed in a 42-year-old African-American woman in the space of a few years; we are reporting this case with the aim of drawing attention to this undocumented occurrence, which remains under investigation. CONCLUSIONS: As the three conditions have different natural histories and require different treatment modalities, it is important to recognize that these diseases may be seen sequentially. This case emphasizes the importance of reviewing peripheral blood smears for evaluation of thrombocytopenia and bone marrow aspirations for diagnosis of thrombocythemia in order to reach an accurate diagnosis and tailor therapy accordingly. Moreover, this case demonstrates the variability and complexity of platelet disorders. This occurrence of three different types of platelet disorders in one patient remains a pure observation on our part; regardless, this does raise the possibility of a common underlying, as yet undiscovered, pathophysiology that could explain the phenomenon.

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