Dependent Functional Status is a Risk Factor for Perioperative and Postoperative Complications After Total Hip Arthroplasty.

BACKGROUND: As the population ages, the need for total hip arthroplasty (THA) will increase. However, this will be associated with an increase in comorbidities and a decrease in the ability to independently perform activities of daily living (ADLs). This study was designed to evaluate the impact preoperative functional status has on short-term outcomes after THA. METHODS: Primary THAs performed from 2012 to 2016 were identified in the National Surgical Quality Improvement Program database. Final analysis included 115,590 cases. Patients who could perform all ADLs were classified as independent functional status (n = 113,436), and patients requiring assistance with ADLs were classified as dependent functional status (n = 2154). Univariate analysis was used to compare perioperative outcomes and 30-day complication rates. Multivariate regression was then applied to determine if preoperative dependent functional status was an independent risk factor for adverse outcomes. RESULTS: Functionally dependent patients were more likely to experience operative times >120 minutes (odds ratio [OR] = 1.39; P < .001), hospital stays >10 days (OR = 2.96; P < .001), and nonhome discharge (OR = 2.53; P < .001). Dependent functional status was also an independent risk factor for mortality (OR = 3.00; P = .001), reoperation (OR = 1.39; P = .015), readmission (OR = 1.75; P < .001), superficial surgical site infection (OR = 1.96; P = .002), wound dehiscence (OR = 2.72; P = .034), pneumonia (OR = 2.16; P = .001), reintubation (OR = 2.31; P = .007), prolonged ventilator use (OR = 3.01; P = .009), renal failure necessitating dialysis (OR = 3.94; P = .002), urinary tract infection (OR = 1.78; P = .001), blood transfusion (OR = 1.75; P < .001), and sepsis (OR = 2.38; P = .001). CONCLUSIONS: Functionally dependent patients undergoing THA are at higher risk of mortality, adverse perioperative outcomes, and complications. These data may aid for patient counseling and risk stratification.

Preoperative Functional Status Predicts Increased Morbidity Following Total Knee Arthroplasty.

INTRODUCTION: Dependent functional status (DEP) has been associated with higher postoperative adverse events and mortality compared to patients with independent functional status (IND). However, the association between preoperative functional status and perioperative outcomes after primary TKA has not been well reported. Therefore, the purpose of this study was to evaluate this association. Specifically, we asked: 1) does preoperative functional status impact perioperative outcomes following primary TKA, and 2) is DEP functional status prior to primary TKA an independent risk factor for 30-day complications?

Team Approach: Management of Pathologic Fractures.

¼: Optimal care for pathologic fractures centers on the use of a multidisciplinary team; thus, whenever there is a concern for pathologic fracture and proper workup is unable to be performed, prompt referral to a center equipped to manage these injuries should occur. ¼: Fixation strategies for pathologic fractures must take into account patient characteristics, cancer subtypes, and overall goals of treatment. ¼: As the treatments of cancers improve, patient life expectancy with disease will improve as well. This will lead to an increase in the incidence of impending or completed pathologic fractures. The broader subspecialties of orthopaedics must be aware of general principles in the diagnosis and management of these injuries.

Musculoskeletal Oncology Fellowship Websites: A Comprehensive Assessment and Cross-Sectional Content Analysis.

This manuscript evaluates the utility of Musculoskeletal Oncology (MSK Oncology) fellowship program websites and identifies areas for improvement. This study identified 20 MSK Oncology programs using two public databases, allocated 45 criteria domains into 6 categories, and evaluated each program independently. MSK Oncology programs had limited information (34%) on their websites, particularly under the "People" category. It is recommended that programs include more information about current fellows and their training background, faculty publications, and alumni descriptions. MSK Oncology program websites should contain necessary information for prospective applicants, particularly considering the increased virtual world during and after the COVID-19 pandemic. Websites should be more comprehensive for applicants in their process of choosing their preferred programs and submitting their rank order lists.

Review article: Patient characteristics that act as risk factors for intraoperative complications in hip, knee, and shoulder arthroplasties.

The number of annual THA's, TKA's, and TSA's is set to increase significantly by the year 2030, making it imperative to understand the risks for negative outcomes in these procedures. While research has studied the patient risk factors for perioperative and postoperative complications, there has been relatively little research for intraoperative complications. After a thorough literature review, the most supported finding was that patients with a BMI >30 had significantly more intraoperative blood loss than those with a BMI <30. All other relationships between patient risk factors and intraoperative complications of interest were inadequately studied.

Preliminary Analysis of a Modified Screening Tool to Increase the Frequency of Palliative Care Consults.

PURPOSE: Palliative care interventions have been shown to improve patient quality of life but the benefit may be less if interventions occur late in the patient's disease process. The objective of this study was to evaluate whether an objective screening tool could improve the frequency and timeliness of palliative care consultation. METHODS: Using a quasi-experimental design with 2 geographically separate medical intensive care units (MICUs), the control MICU continued existing consultation practice and the intervention MICU implemented a screening tool with each new admission. Any item checked on the screening tool triggered a palliative care consult within 24 hours of admission to the MICU. RESULTS: A total of 223 MICU admissions were evaluated: 156 patients in the control group and 67 patients in the intervention group. More consults were generated in the intervention group (22.39%) compared to the control group (7.05%; P < .001). The median time to consultation was lower in the intervention group compared to the control group (1 day vs 2 days; P < .01). CONCLUSION: Implementing a simple, objective screening tool increased palliative consultation rates and decreased median time to palliative consultation in our institution's MICU.