CT guided biopsy for osteodiscitis reduces cost of hospitalization in the landscape of increasing intravenous drug use: A single center retrospective analysis.

OBJECTIVE: Osteodiscitis has been demonstrated to show significant morbidity and mortality. Cultures and CT guided biopsy (CTB) are commonly used diagnosis of osteodiscitis. This study's purpose is to evaluate the cost burden of CTB and to evaluate how IVDU affects patient management in the setting of osteodiscitis. METHODS: Patients admitted for osteodiscitis from 2011-2021 were retrospectively reviewed and stratified into cohorts by CTB status. Additional cohorts were stratified by Intravenous Drug Use (IVDU). Patient demographics, total cost of hospitalization, length of hospitalization, time to biopsy, IVDU status, and other factors were recorded. T-Test, Chi-squared analysis, and ANOVA were used for statistical analysis. RESULTS: Total cost of hospitalization was recorded for 140 patients without CTB and 346 patients with CTB. Average cost of hospitalization for non-CTB was $227,317.86 compared to CTB at $119,799.20 (p < 0.001). Length of stay (LOS) was found to be 18.01 days for non-CTB and 14.07 days for CTB patients (0.00282). When stratified by days until biopsy, patients who had CTB sooner, had significantly reduced cost of hospitalization (p = 0.0003). Patients with IVDU history were significantly younger (p < 0.001) with lower BMI (p < 0.001) and a significantly different clinical profile. There was a significant difference in positive open biopsy when separated by IVDU status (p = 0.025). CONCLUSION: CTB was associated with significantly reduced cost of hospitalization and LOS compared to non-CTB. IVDU patients with osteodiscitis have significantly different clinical profiles than non-IVDU that may impact diagnosis and treatment. Further work is indicated to elucidate causes of these differences to provide high value care to patients with osteodiscitis.

The role of body mass index on survivorship and clinical outcomes in total shoulder arthroplasty.

BACKGROUND: Increased body mass index (BMI) is a potential risk factor for poorer outcomes and complications. However, the influence of BMI on the long-term outcomes of anatomic and reverse total shoulder arthroplasty (aTSA and rTSA) remains to be fully elucidated. METHODS: Institutional records were queried to identify patients who underwent primary TSA between 2009-2020 with a minimum of 2 years of clinical follow-up. Retrospective review was performed to collect demographics, comorbidity status, and range of motion and strength measurements in forward elevation, external rotation, and internal rotation. Patients were called to obtain patient reported outcomes. Patients were stratified into 3 cohorts, by BMI: underweight or normal weight (U/NW, BMI≤25), overweight (OW, 2530). RESULTS: Among 466 TSA patients, 245 underwent aTSA while 221 underwent rTSA. In the aTSA cohort, 40 were classified as U/NW, 72 as OW, and 133 as obese. Comparatively, the rTSA cohort was composed of 33 U/NW, 79 OW, and 209 obese patients. aTSA and rTSA patients had an average follow-up of 5.8±3.2 years and 4.5±2.3 years, respectively. No differences were found in age at surgery for the aTSA group (U/NW: 65.2±7.9 vs obese: 61.9±8.9 years; p=0.133), however, in the rTSA cohort, BMI was found to be inversely related to age at surgery (U/NW: 72.4±8.8 vs obese: 65.7±8.3 years; p<0.001). Across all BMI cohorts, patients saw great improvement in range of motion and strength. Postoperative patient reported outcomes for TSA did not vary by BMI in SANE, SST, VAS pain, and ASES scores. There was no significant difference in survival rates at 10-year follow-up in aTSA (U/NW: 95.8% vs obese: 93.2%; p=0.753) or rTSA (U/NW: 94.7% vs obese: 94.5%; p=0.791). CONCLUSION: With dramatic improvements in range of motion, minimal differences in patient reported outcomes, and high rates of implant survival, TSA is a safe and effective treatment option for all patients, including for overweight and obese patients.

Demineralized Bone Matrix and Fibers in Spinal Fusion.

Formation of bony fusion after arthrodesis depends on osteoinduction, osteoconduction, and osteogenesis. Traditionally, the patient's own bone, or autograft, has been used to provide biological material necessary for these steps. However, the amount of autograft obtainable is often inadequate. Modern spine surgery has adopted the use of many autograft extenders or replacements, such as demineralized bone matrix or fibers. The present article covers the history of bone grafting, the production and technical details of demineralized bone matrix, and the evidence supporting its use in spine fusions.