Accuracy assessment between computer-guided surgery planning and actual tooth position during tooth autotransplantation.

BACKGROUND/AIM: This study aims to evaluate the precision and efficacy of utilizing computer-aided design (CAD) in combination with three-dimensional printing technology for tooth transplantation. MATERIAL AND METHODS: This study analysed 50 transplanted teeth from 48 patients who underwent tooth transplantation surgery with the aid of CAD and positional guides. A consistent coordinate system was established using preoperative and postoperative cone-beam computed tomography images. Linear displacements and angular deviations were calculated by identifying key regions in both virtual designs and actual transplanted teeth. Additionally, an analysis was conducted to explore potential factors influencing these deviations. RESULTS: The mean cervical deviation, apical deviation, and angular deviation among the 50 transplanted teeth were 1.16 ± 0.57 mm, 1.80 ± 0.94 mm, and 6.82 ± 3.14°, respectively. Cervical deviation was significantly smaller than apical deviation. No significant difference in deviation was observed among different recipient socket locations, holding true for both single-root, and multi-root teeth. However, a significant difference was noted in apical deviation between single-root and multi-root teeth. Our analysis identified a correlation between apical deviation and root length, leading to the development of a prediction model: Apical deviation = 0.1390 × (root length) + 0.2791. CONCLUSIONS: The postoperative position of the donor teeth shows discrepancies compared to preoperative simulation when utilizing CAD and 3D printed templates during autotransplantation procedures. Continual refinement of preoperative design is a crucial endeavour.

Evidence-based Perioperative Practice Utilization among Various Racial Populations-A Retrospective Cohort Trending Analysis of Lower Extremity Total Joint Arthroplasty Patients.

BACKGROUND: Various studies have demonstrated racial disparities in perioperative care and outcomes. The authors hypothesize that among lower extremity total joint arthroplasty patients, evidence-based perioperative practice utilization increased over time among all racial groups, and that standardized evidence-based perioperative practice care protocols resulted in reduction of racial disparities and improved outcomes. METHODS: The study analyzed 3,356,805 lower extremity total joint arthroplasty patients from the Premier Healthcare database (Premier Healthcare Solutions, Inc., USA). The exposure of interest was race (White, Black, Asian, other). Outcomes were evidence-based perioperative practice adherence (eight individual care components; more than 80% of these implemented was defined as "high evidence-based perioperative practice"), any major complication (including acute renal failure, delirium, myocardial infarction, pulmonary embolism, respiratory failure, stroke, or in-hospital mortality), in-hospital mortality, and prolonged length of stay. RESULTS: Evidence-based perioperative practice adherence rate has increased over time and was associated with reduced complications across all racial groups. However, utilization among Black patients was below that for White patients between 2006 and 2021 (odds ratio, 0.94 [95% CI, 0.93 to 0.95]; 45.50% vs. 47.90% on average). Independent of whether evidence-based perioperative practice components were applied, Black patients exhibited higher odds of major complications (1.61 [95% CI, 1.55 to 1.67] with high evidence-based perioperative practice; 1.43 [95% CI, 1.39 to 1.48] without high evidence-based perioperative practice), mortality (1.70 [95% CI, 1.29 to 2.25] with high evidence-based perioperative practice; 1.29 [95% CI, 1.10 to 1.51] without high evidence-based perioperative practice), and prolonged length of stay (1.45 [95% CI, 1.42 to 1.48] with high evidence-based perioperative practice; 1.38 [95% CI, 1.37 to 1.40] without high evidence-based perioperative practice) compared to White patients. CONCLUSIONS: Evidence-based perioperative practice utilization in lower extremity joint arthroplasty has been increasing during the last decade. However, racial disparities still exist with Black patients consistently having lower odds of evidence-based perioperative practice adherence. Black patients (compared to the White patients) exhibited higher odds of composite major complications, mortality, and prolonged length of stay, independent of evidence-based perioperative practice use, suggesting that evidence-based perioperative practice did not impact racial disparities regarding particularly the Black patients in this surgical cohort.

The Perioperative Use of Benzodiazepines for Major Orthopedic Surgery in the United States.

BACKGROUND: Despite numerous indications for perioperative benzodiazepine use, associated risks may be exacerbated in elderly and comorbid patients. In the absence of national utilization data, we aimed to describe utilization patterns using national claims data from total hip/knee arthroplasty patients (THA/TKA), an increasingly older and vulnerable surgical population. METHODS: We included data on 1,863,996 TKAs and 985,471 THAs (Premier Healthcare claims data, 2006-2019). Benzodiazepine utilization (stratified by long- and short-acting agents) was assessed by patient- and health care characteristics, and analgesic regimens. Given the large sample size, standardized differences instead of P values were utilized to signify meaningful differences between groups (defined by value >0.1). RESULTS: Among 1,863,996 TKA and 985,471 THA patients, the utilization rate of benzodiazepines was 80.5% and 76.1%, respectively. In TKA, 72.6% received short-acting benzodiazepines, while 7.9% received long-acting benzodiazepines, utilization rates 68.4% and 7.7% in THA, respectively. Benzodiazepine use was particularly more frequent among younger patients (median age [interquartile range {IQR}]: 66 [60-73]/64 [57-71] among short/long-acting compared to 69 [61-76] among nonusers), White patients (80.6%/85.4% short/long-acting versus 75.7% among nonusers), commercial insurance (36.5%/34.0% short/long-acting versus 29.1% among nonusers), patients receiving neuraxial anesthesia (56.9%/56.5% short/long-acting versus 51.5% among nonusers), small- and medium-sized (≤500 beds) hospitals (68.5% in nonusers, and 74% and 76.7% in short- and long-acting benzodiazepines), and those in the Midwest (24.6%/25.4% short/long-acting versus 16% among nonusers) in TKA; all standardized differences ≥0.1. Similar patterns were observed in THA except for race and comorbidity burden. Notably, among patients with benzodiazepine use, in-hospital postoperative opioid administration (measured in oral morphine equivalents [OMEs]) was substantially higher. This was even more pronounced in patients who received long-acting agents (median OME with no benzodiazepines utilization 192 [IQR, 83-345] vs 256 [IQR, 153-431] with short-acting, and 329 [IQR, 195-540] with long-acting benzodiazepine administration). Benzodiazepine use was also more frequent in patients receiving multimodal analgesia (concurrently 2 or more analgesic modes) and regional anesthesia. Trend analysis showed a persistent high utilization rate of benzodiazepines over the last 14 years. CONCLUSIONS: Based on a representative sample, 4 of 5 patients undergoing major orthopedic surgery in the United States receive benzodiazepines perioperatively, despite concerns for delirium and delayed postoperative neurocognitive recovery. Notably, benzodiazepine utilization was coupled with substantially increased opioid use, which may project implications for perioperative pain management.

Pre-existing Disparities and Potential Implications for the Rapid Expansion of Telemedicine in Response to the Coronavirus Disease 2019 Pandemic.

BACKGROUND: Concerns exist regarding exacerbation of existing disparities in health care access with the rapid implementation of telemedicine during the coronavirus disease 2019 (COVID-19) pandemic. However, data on pre-existing disparities in telemedicine utilization is currently lacking. OBJECTIVE: We aimed to study: (1) the prevalence of outpatient telemedicine visits before the COVID-19 pandemic by patient subgroups based on age, comorbidity burden, residence rurality, and median household income; and (2) associated diagnosis categories. RESEARCH DESIGN: This was a retrospective cohort study. SUBJECT: Commercial claims data from the Truven MarketScan database (2014-2018) representing n=846,461,609 outpatient visits. MEASURES: We studied characteristics and utilization of outpatient telemedicine services before the COVID-19 pandemic by patient subgroups based on age, comorbidity burden, residence rurality, and median household income. Disparities were assessed in unadjusted and adjusted (regression) analyses. RESULTS: With overall telemedicine uptake of 0.12% (n=1,018,092/846,461,609 outpatient visits) we found that pre-COVID-19 disparities in telemedicine use became more pronounced over time with lower use in patients who were older, had more comorbidities, were in rural areas, and had lower median household incomes (all trends and effect estimates P<0.001). CONCLUSION: These results contextualize pre-existing disparities in telemedicine use and are crucial in the monitoring of potential disparities in telemedicine access and subsequent outcomes after the rapid expansion of telemedicine during the COVID-19 pandemic.

Cancellation of Elective Surgery and Intensive Care Unit Capacity in New York State: A Retrospective Cohort Analysis.

BACKGROUND: In response to the coronavirus disease 2019 (COVID-19) pandemic, New York State ordered the suspension of all elective surgeries to increase intensive care unit (ICU) bed capacity. Yet the potential impact of suspending elective surgery on ICU bed capacity is unclear. METHODS: We retrospectively reviewed 5 years of New York State data on ICU usage. Descriptions of ICU utilization and mechanical ventilation were stratified by admission type (elective surgery, emergent/urgent/trauma surgery, and medical admissions) and by geographic location (New York metropolitan region versus the rest of New York State). Data are presented as absolute numbers and percentages and all adult and pediatric ICU patients were included. RESULTS: Overall, ICU admissions in New York State were seen in 10.1% of all hospitalizations (n = 1,232,986/n = 12,251,617) and remained stable over a 5-year period from 2011 to 2015. Among n = 1,232,986 ICU stays, sources of ICU admission included elective surgery (13.4%, n = 165,365), emergent/urgent admissions/trauma surgery (28.0%, n = 345,094), and medical admissions (58.6%, n = 722,527). Ventilator utilization was seen in 26.3% (n = 323,789/n = 1232,986) of all ICU patients of which 6.4% (n = 20,652), 32.8% (n = 106,186), and 60.8% (n = 196,951) was for patients from elective, emergent, and medical admissions, respectively. New York City holds the majority of ICU bed capacity (70.0%; n = 2496/n = 3566) in New York State. CONCLUSIONS: Patients undergoing elective surgery comprised a small fraction of ICU bed and mechanical ventilation use in New York State. Suspension of elective surgeries in response to the COVID-19 pandemic may thus have a minor impact on ICU capacity when compared to other sources of ICU admission such as emergent/urgent admissions/trauma surgery and medical admissions. More study is needed to better understand how best to maximize ICU capacity for pandemics requiring heavy use of critical care resources.