Home health care is associated with an increased risk of readmission and cost of care without reducing risk of complication following shoulder arthroplasty: a propensity-score analysis.

BACKGROUND: Home health services provide patients with additional professional care and supervision following discharge from the hospital to theoretically reduce the risk of complication and reduce health care utilization. The aim of this investigation was to determine if patients assigned home health services following total shoulder arthroplasty (anatomic [TSA] and reverse [RSA]) exhibited lower rates of medical complications, lower health care utilization, and lower cost of care compared with patients not receiving these services. METHODS: A national insurance database was retrospectively reviewed to identify all patients undergoing primary TSA and RSA from 2010 to 2019. Patients who received home health services were matched using a propensity score algorithm to a set of similar patients who were discharged home without services. We compared medical complication rates, emergency department (ED) visits, readmissions, and 90-day cost of care between the groups. Multivariate regression analysis was performed to determine the independent effect of home health services on all outcomes. RESULTS: A total of 1119 patients received home health services and were matched to 11,190 patients who were discharged home without services. There was no significant difference in patients who received home health services compared with those who did not receive home health services with respect to rates of ED visits within 30 days (OR 1.293; P = .0328) and 90 days (OR 1.215; P = .0378), whereas the home health group demonstrated increased readmissions within 90 days (OR 1.663; P < .001). For all medical complications, there was no difference between cohorts. Episode-of-care costs for home health patients were higher than those discharged without these services ($12,521.04 vs. $9303.48; P < .001). CONCLUSION: Patients assigned home health care services exhibited higher cost of care and readmission rates without a reduction in the rate of complication or early return to the ED. These findings suggest that home health care services should be strongly analyzed on a case-by-case basis to determine if a patient may benefit from its implementation.

Graft Augmentation of Rotator Cuff Repair Improves Load to Failure But Does Not Affect Stiffness or Gap Formation: A Meta-analysis of Biomechanical Studies.

PURPOSE: To examine the biomechanical properties of rotator cuff repair with graft augmentation (RCR-G) with regard to ultimate load to failure, gap displacement, and stiffness. METHODS: A systematic review was performed by searching PubMed, the Cochrane library, and Embase using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify studies that analyzed the biomechanical properties of RCR-G. The search string implemented used the concepts "rotator cuff" and "graft," and "biomechanical" OR "cadaver." Meta-analysis was performed to provide a quantitative comparison of the 2 techniques. Primary outcome measures were ultimate load to failure (N), gap displacement (mm), and stiffness (N/mm). RESULTS: Our initial search yielded 1,493 articles for review. Following screening for inclusion criteria, 8 studies were included in the meta-analysis, including a total of 191 cadaveric specimens (106 RCR-G, 85 RCR). The pooled analysis from 6 studies reporting on ultimate load to failure revealed a statistically significant difference in favor of RCR-G compared with RCR (P < .001). Pooled analysis from 6 studies reporting on gap displacement failed to reveal a difference between RCR-G and RCR (P = .719). Pooled analysis from 4 studies reporting on stiffness failed to reveal a difference between RCR-G and RCR (P = .842). CONCLUSIONS: Graft augmentation of RCR in vitro resulted in significantly increased ultimate load to failure, with no influence on gap formation or stiffness. CLINICAL RELEVANCE: The biomechanical advantage of RCR with graft augmentation demonstrated via increased ultimate load to failure in cadaveric studies may provide an explanation for the decreased RCR retear rates and improved patient reported outcomes reported in the clinical literature regarding graft augmentation.

Management of the Mangled Extremity.

Mangled extremities represent one of the most challenging injuries. They indicate the need for a comprehensive trauma assessment to rule out coexisting injuries. Treatment options include amputation and attempts at limb salvage. Although both have been associated with chronic disability, new surgical techniques and evolving rehabilitation options offer hope for the future.

The Impact of Signaling on the 2022 to 2023 Orthopaedic Residency Application Cycle: A Survey of Incoming Residents.

Background: During the 2022 to 2023 orthopaedic surgery residency application cycle, "signaling" was added, allowing applicants to communicate strong interest to 30 programs of their choosing. This study's purpose was to evaluate signaling's impact on the 2022 to 2023 application cycle. Methods: A cross-sectional survey was distributed to applicants who applied to a single residency program. We evaluated how many interviews the average applicant received, what proportion of interviews came from programs they had signaled, and what percentage of applicants matched at a program they had signaled. We stratified data by American Orthopaedic Association status, United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores, research items, sex, and race. Results: This survey was distributed to 611 applicants, with 124 (20.3%) responding to the survey. Ninety-five respondents (76.6%) matched. The percentage of applicant interviews that came from signaled programs was 78.7%. Ninety-one percent of matched applicants matched at a program they signaled. Sixty-three percent of matched applicants performed an away rotation at their matched programs. Forty-five percent of applicants felt that signaling incentivized reducing the programs they applied to, and applicants gave signaling a high favorability rating of 4/5. Applicants with Alpha Omega Alpha status received more interviews per application (0.18 ± 0.11 vs. 0.10 ± 0.10, p < 0.001) and more interviews from programs they did not signal (74% of interviews from signaled programs vs. 90% of interviews from signaled programs, p < 0.001). Higher Step 1 and Step 2 scores were associated with more interviews per application (Step 1: 0.16 ± 0.12 vs. 0.12 ± 0.08, p = 0.032) (Step 2: 0.16 ± 0.11 vs. 0.12 ± 0.09, p = 0.032). Conclusion: Orthopaedic residency applicants received most of their interviews from programs that they signaled, with an overwhelming majority matching at signaled program. Alpha Omega Alpha status and high USMLE scores were associated with more interviews granted per application, regardless of signaling status. Signaling seems to be a favorable option for orthopaedic applicants. Data from future application cycles will help further evaluate signaling's impact on the orthopaedic match.

No difference in load to failure or stiffness between transosseous tunnels, suture anchors, and cortical buttons for pectoralis major tendon repair: a systematic review & meta-analysis.

PURPOSE: Surgical options for pectoralis major tendon tears include primary repair, though there is no consensus as to which constructs are biomechanically superior for repair. METHODS: A systematic review was performed by searching PubMed, the Cochrane library, and Embase using PRISMA guidelines to identify studies that analyzed the biomechanical properties of bone tunnels (BT), cortical buttons (CB) and suture anchors (SA) techniques for pectoralis major tendon repair. The search phrase implemented was 'pectoralis major tendon repair biomechanics'. Studies that did not evaluate biomechanical outcome data, evaluated partial pectoralis major tendon tears, and non-English articles were excluded. Evaluated outcomes included ultimate load to failure (N) and stiffness (N/mm). RESULTS: Six studies met inclusion criteria, including a total of 124 cadaveric specimens, for pectoralis major tendon repair comparing BT with SA and CB. Pooled analysis from four studies reporting on ultimate load to failure between BT and SA failed to reveal a difference between BT and SA (p = 0.489). Pooled analysis from two studies reporting on stiffness failed to reveal a difference in favor of BT compared to SA (p = 0.705). Pooled analysis from four studies reporting on ultimate load to failure between BT and CB failed to reveal a difference between BT and CB (p = 0.567). Pooled analysis from two studies reporting on stiffness failed to reveal a difference in favor of BT compared to CB (p = 0.701). CONCLUSIONS: There was no difference in load to failure or stiffness when using BT, CB, or SA in pectoralis major tendon repairs. This review reveals that clinical outcomes may better inform which fixation construct to implement in pectoralis major tendon repairs. LEVEL OF EVIDENCE: I.