Emerging drugs for the treatment of benign prostatic hyperplasia: a 2023 update.

INTRODUCTION: Benign prostatic hyperplasia (BPH) is a condition that affects over 50% of men as they enter their fifth decade of life, often leading to lower urinary tract symptoms (LUTS). Primary treatment options include alpha blockers, 5-alpha reductase inhibitors, and phosphodiesterase-5 inhibitors. However, these medications can have some side effects, and there is a noticeable dearth of information addressing the long-term use of these medications. Thus, the exploration of all treatment modalities helps ensure patients receive personalized and effective care. Consequently, the primary objective of this review is to identify potential emerging medications for the treatment of BPH. AREAS COVERED: We conducted an extensive review of articles discussing pharmacotherapy for BPH spanning the last 15 years. Our information gathering process involved Scopus, PubMed-MEDLINE, Cochrane, Wiley Online Library Google Scholar, ClinicalTrials.gov, and the PharmaProjects database. This approach ensures that readers gain an in-depth knowledge of the existing therapeutic agents as well as promising avenues for managing BPH. EXPERT OPINION: BPH treatment targets a patient's specific constellation of symptoms. Therefore, a broad knowledge base encompassing various treatment options is paramount in ensuring optimal treatment. Looking forward, the emphasis on personalization promises to reshape the landscape of BPH treatment and improve patient outcomes.

Fragility of overactive bladder medication clinical trials: A systematic review.

PURPOSE: Overactive bladder (OAB) syndrome significantly impairs quality of life, often necessitating pharmacological interventions with associated risks. The fragility of OAB trial outcomes, as measured by the fragility index (FI: smallest number of event changes to reverse statistical significance) and quotient (FQ: FI divided by total sample size expressed as a percentage), is critical yet unstudied. MATERIALS AND METHODS: We conducted a systematic search for randomized controlled trials on OAB medications published between January 2000 and August 2023. Inclusion criteria were trials with two parallel arms reporting binary outcomes related to OAB medications. We extracted trial details, outcomes, and statistical tests employed. We calculated FI and FQ, analyzing associations with trial characteristics through linear regression. RESULTS: We included 57 trials with a median sample size of 211 participants and a 12% median lost to follow-up. Most studies investigated anticholinergics (37/57, 65%). The median FI/FQ was 5/3.5%. Larger trials were less fragile (median FI 8; FQ 1.0%) compared to medium (FI: 4; FQ 2.5%) and small trials (FI: 4; FQ 8.3%). Double-blinded studies exhibited higher FQs (median 2.9%) than unblinded trials (6.7%). Primary and secondary outcomes had higher FIs (median 5 and 6, respectively) than adverse events (FI: 4). Each increase in 10 participants was associated with a +0.19 increase in FI (p < 0.001). CONCLUSIONS: A change in outcome for a median of five participants, or 3.5% of the total sample size, could reverse the direction of statistical significance in OAB trials. Studies with larger sample sizes and efficacy outcomes from blinded trials were less fragile.

Genomics in active surveillance and post-prostatectomy patients: A review of when and how to use effectively.

PURPOSE OF REVIEW: Prostate cancer (PCa) represents a significant health burden globally, ranking as the most diagnosed cancer among men and a leading cause of cancer-related mortality. Conventional treatment methods such as radiation therapy or radical prostatectomy have significant side effects which often impact quality of life. As our understanding of the natural history and progression of PCa has evolved, so has the evolution of management options. RECENT FINDINGS: Active surveillance (AS) has become an increasingly favored approach to the management of very low, low, and properly selected favorable intermediate risk PCa. AS permits ongoing observation and postpones intervention until definitive treatment is required. There are, however, challenges with selecting patients for AS, which further emphasizes the need for more precise tools to better risk stratify patients and choose candidates more accurately. Tissue-based biomarkers, such as ProMark, Prolaris, GPS (formerly Oncotype DX), and Decipher, are valuable because they improve the accuracy of patient selection for AS and offer important information on the prognosis and severity of disease. By enabling patients to be categorized according to their risk profiles, these biomarkers help physicians and patients make better informed treatment choices and lower the possibility of overtreatment. Even with their potential, further standardization and validation of these biomarkers is required to guarantee their broad clinical utility. Active surveillance has emerged as a preferred strategy for managing low-risk prostate cancer, and tissue-based biomarkers play a crucial role in refining patient selection and risk stratification. Standardization and validation of these biomarkers are essential to ensure their widespread clinical use and optimize patient outcomes.

Factors that influence the mortality of patients following hip hemiarthroplasty.

INTRODUCTION: Hip hemiarthroplasty (HHA) is one of the most common types of orthopedic surgery. With the prevalence and utilization of the surgery increasing year after year, this procedure is found to be associated with severe postoperative complications and eventually mortality. Thus, it is crucial to understand the factors that increase the risk of mortality following HHA. METHODS: Using the Nationwide Inpatient Sample (NIS) database, patients undergoing HHA from 2016 to 2019 were identified. This sample was stratified into a mortality group and a control group. The data regarding patients' demographics, co-morbidities, and associated complications were compared between the groups. RESULTS: Of the 84,067 patients who underwent the HHA procedures, 1,327 (1.6%) patients died. Additionally, the mortality group had a higher percentage of patients who were non-electively admitted (P < 0.001) and diabetic patients with complications (P < 0.001), but lower incidences of tobacco-related disorders (P < 0.001). Significant differences were also seen in age (P < 0.001), length of stay (P < 0.001), and total charges (P < 0.001) between the two groups. Preoperatively, those aged > 70 years (OR: 2.11, 95% CI [1.74, 2.56], P < 0.001) had diabetes without complications (OR: 0.32, 95% CI [0.23, 0.44], P < 0.001), tobacco-related disorders (OR: 0.24, 95% CI [0.17, 0.34], P < 0.001) and increased rates of mortality after HHA. Postoperatively, conditions, such as pulmonary embolisms (OR: 6.62, 95% CI [5.07, 8.65], P < 0.001), acute renal failure (OR: 4.58 95% CI [4.09, 5.13], P < 0.001), pneumonia (95% CI [2.72, 3.83], P < 0.001), and myocardial infarctions (OR: 2.65, 95% CI [1.80, 3.92], P < 0.001) increased likelihood of death after undergoing HHA. Patients who were electively admitted (OR: 0.46 95% CI [0.35, 0.61], P < 0.001) had preoperative obesity (OR: 0.67, 95% CI [0.44, 0.84], P = 0.002), and a periprosthetic dislocation (OR: 0.51, 95% CI [0.31, 0.83], P = 0.007) and were found to have a decreased risk of mortality following THA. CONCLUSIONS: Analysis of pre- and postoperative complications relating to HHA revealed that several comorbidities and postoperative complications increased the odds of mortality. Old age, pulmonary embolisms, acute renal failure, pneumonia, and myocardial infraction enhanced the odds of post-HHA mortality.

Pernicious Anemia Unveiled: Unusual Hemolytic Complications and Clinical Implications.

Pernicious anemia (PA) is an autoimmune condition resulting in impaired vitamin B12 absorption that commonly presents with gastritis and neurological symptoms. In rare cases, associated vitamin B12 deficiency can contribute to significant red blood cell lysis, and patients can present with PA-induced pseudo-thrombotic microangiopathy (TMA) hemolytic anemia. This case describes a 59-year-old male presenting with a two-week history of gastrointestinal pain with bleeding who had anemia and hemodynamic instability on initial evaluation. After the endoscopy/colonoscopy did not reveal any active sources of bleeding and packed red blood cells failed to stabilize the patient, it was found that he had low serum B12 with anti-intrinsic factor and anti-parietal cell antibodies. A coordinated clinical approach, including parenteral cyanocobalamin and daily oral folic acid supplementation, stabilized the patient, highlighting the importance of distinguishing PA-induced pseudo-TMA from true TMA hemolytic anemia.

Atypical Papillary Dysplasia of the Bladder Neck.

As the fourth most frequent disease in men, bladder cancer has a significant financial impact on healthcare. Because atypical dysplasia and papillary forms in bladder cancer are uncommon, there is a dearth of information on them. This study attempts to fill that gap. In the case study that is being presented, a 65-year-old man with a history of prostate cancer was admitted due to unusual urine cytology results that showed bladder papillary atypia. A distinct lesion on the bladder's dome that resembled a raspberry color was discovered by cystoscopy and transurethral resection of the bladder tumor (TURBT), which led to numerous biopsies and resections. Pathology demonstrated a significant urothelial proliferation. The study highlights the variety of morphologies found in atypical dysplastic lesions and the possibility that these lesions could develop into cancer. The significance of identifying atypical dysplastic lesions is emphasized in the study's conclusion, notably in patients with a history of prostate cancer, and highlights the need for further investigation in this domain.

Associations of sex hormone ratios with metabolic syndrome and inflammation in US adult men and women.

Background: Sex hormones play a critical role in sex differences and cardiovascular disease risk associated with metabolic syndrome (MS) and inflammation. However, the associations of sex hormone ratios with metabolic and inflammatory markers are unclear according to sex and age differences. We evaluated the associations of sex hormone ratios with MS and inflammation among males and females. Methods: A retrospective cross-sectional study was conducted by including all adults from the National Health and Nutrition Examination Survey cycles 2013-2016 and excluding any pregnant women, heart disease, diabetes, and those currently taking insulin. MS was defined using the National Cholesterol Education Program criteria and a high-sensitivity C-reactive protein (CRP) level>3 mg/L was defined as a high CRP. Measures of MS components and CRP concentrations were also analyzed. The primary exposures were testosterone to estradiol (excess androgen index), testosterone to sex hormone-binding globulin (free androgen index), and estradiol to sex hormone-binding globulin (free estradiol index). The adjusted associations were summarized with a relative risk (RR) and 95% confidence interval (CI). Results: This study included 9167 subjects with 4360 males and 4807 females. Increases in free estradiol index were positively associated with MS (RR=1.48; 95%CI: 1.39, 1.58; RR=1.31; 95%CI: 1.22, 1.40) and high CRP (RR=1.49; 95%CI: 1.25, 1.77; RR=1.26; 95%CI: 1.06, 1.50) in men with age<50 years and age≥50 years, respectively. Similarly, higher free estradiol index was also robustly associated with increased prevalence of MS (RR=1.22; 95%CI: 1.15, 1.28) and high CRP (RR=1.68; 95%CI: 1.48, 1.90) in women with age ≥50 years. Among women with age<50 years, a higher free androgen index was associated with MS (RR=1.34; 95%CI: 1.25, 1.42) and high CRP (RR=1.13; 95%CI: 1.02, 1.25). These associations were unchanged even after adjusting for all sex hormones. Conclusion: Free estradiol index was consistently and positively associated with MS and high CRP in males of all ages and older females. Free androgen index was positively associated with MS and high CRP in females with age<50 years.

3D-Printed Spine Models for Planning Staged Minimally Invasive Transverse Process Resections for Bertolotti Syndrome: Technical Note.

Background: Three-dimensional (3D) printing has enabled numerous advances in spine surgery execution and education. However, few examples exist to outline how this technology can aid the performance of complex spine surgery using minimally invasive surgery (MIS) techniques. Therefore, we present a case that illustrates the benefits of 3D-printed spine model production before and after correction of a congenital lumbosacral anomaly using an MIS approach. Case Report: A 40-year-old woman with Bertolotti syndrome underwent a staged bilateral L6 MIS transverse process resection for the treatment of severe and progressive axial back pain which had repeatedly failed conservative management. 3D-printed spine models were used for pre- and post-operative surgical planning and patient counseling. Conclusion: 3D-printed spine models can aid in the planning of complex spine cases suited for an MIS approach.

The New York Section EMPIRE Collaborative: Piloting a Multi-Institutional, Simulation-Based Surgical Skills Boot Camp for Junior Urology Residents.

INTRODUCTION: Since the integration of the intern year into urology residencies, programs are mandated to introduce fundamental skills to junior residents. Our goal was to assess the impact of one such program: the 2023 New York Section of the AUA (NYS-AUA) EMPIRE (Educational Multi-institutional Program for Instructing REsidents) Boot Camp. METHODS: Junior urology residents from all 10 NYS-AUA institutions attended a free EMPIRE Boot Camp on June 9, 2023. The seminar covered procedural skills including urethral catheterization, cystoscopy, renal and bladder ultrasound, transrectal prostate ultrasound with biopsy, and an introduction to robotics/laparoscopy. Sessions focused on urologic emergencies and postoperative scenarios. Participants completed questionnaires before, immediately after, and 6 months post course, assessing comfort with procedures and overall program quality using a 5-point Likert scale and free text responses. t Tests compared pre and immediate/6-month post scores. RESULTS: Forty junior residents, along with faculty and resident instructors from all 10 NYS-AUA programs, participated. Of the 40 trainees, 35 (87.5%) completed pre- and immediate post-boot camp surveys, while 23 (57.5%) responded to the 6-month follow-up survey. Ratings showed significant improvement in comfort with basic urologic technical skills for 13 out of 14 domains (93%) immediately after the course and at the 6-month mark. Attendees reported notably higher comfort levels in managing obstructive pyelonephritis (P = .003) and postoperative complications (P = .001) following didactic sessions. CONCLUSIONS: A skills-based, free collaborative urology boot camp for junior residents is feasible and can be effective. Trainees reported improved comfort performing certain technical skills and managing urologic emergencies both immediately after the course and at 6 months of follow-up.

Testicular Radiomics To Predict Pathology At Time of Postchemotherapy Retroperitoneal Lymph Node Dissection for Nonseminomatous Germ Cell Tumor.

INTRODUCTION: Testicular germ cell tumors are the most common malignancy in young adult males. Patients with metastatic disease receive standard of care chemotherapy followed by retroperitoneal lymph node dissection for residual masses >1cm. However, there is a need for better preoperative tools to discern which patients will have persistent disease after chemotherapy given low rates of metastatic germ cell tumor after chemotherapy. The purpose of this study was to use radiomics to predict which patients would have viable germ cell tumor or teratoma after chemotherapy at time of retroperitoneal lymph node dissection. PATIENTS AND METHODS: Patients with nonseminomatous germ cell tumor undergoing postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) between 2008 and 2019 were queried from our institutional database. Patients were included if prechemotherapy computed tomography (CT) scan and postchemotherapy imaging were available. Semiqualitative and quantitative features of residual masses and nodal regions of interest and radiomic feature extractions were performed by 2 board certified radiologists. Radiomic feature analysis was used to extract first order, shape, and second order statistics from each region of interest. Post-RPLND pathology was compared to the radiomic analysis using multiple t-tests. RESULTS: 45 patients underwent PC-RPLND at our institution, with the majority (28 patients) having stage III disease. 24 (53%) patients had teratoma on RPLND pathology, while 2 (4%) had viable germ cell tumor. After chemotherapy, 78%, 53%, and 33% of patients had cystic regions, fat stranding, and local infiltration present on imaging. After radiomic analysis, first order statistics mean, median, 90th percentile, and root mean squares were significant. Strong correlations were observed between these 4 features;a lower signal was associated with positive pathology at RPND. CONCLUSIONS: Testicular radiomics is an emerging tool that may help predict persistent disease after chemotherapy.

Associations of Ambulatory Blood Pressure Measurements With High-Sensitivity Troponin and Natriuretic Peptide Levels in SPRINT.

BACKGROUND: Nighttime blood pressure (BP) has greater prognostic importance for cardiovascular disease (CVD) than daytime BP, but less is known about nighttime and daytime BP associations with measures of subclinical CVD. METHODS: Among 897 Systolic Blood Pressure Intervention Trial Study (SPRINT) participants with 24-hour ambulatory BP monitoring obtained near the 27-month study visit, 849 (95%) had N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) measured at the 24-month study visit. Multivariable linear regression analyses were performed to evaluate the associations of nighttime and daytime BP with cardiac biomarker levels. RESULTS: The mean age was 69 ±â€…12 years, 28% were African American, and mean nighttime and daytime SBP were 121 ±â€…16 mm Hg and 132 ±â€…14 mm Hg, respectively. In multivariable models, compared with the lowest tertile of nighttime systolic BP, the highest tertile was associated with 48% higher NT-proBNP levels (adjusted geometric mean ratio [GMR] = 1.48, 95% CI: 1.22, 1.79), and 19% higher hs-cTnT levels (adjusted GMR = 1.19, 95% CI: 1.07, 1.32). In contrast, the highest vs. lowest tertile of daytime systolic BP was not associated with NT-proBNP (adjusted GMR = 1.09, 95% CI: 0.88, 1.34), but was associated with 16% higher hs-cTnT levels (adjusted GMR = 1.16, 95% CI: 1.04, 1.30). Similar results were observed using diastolic BP. CONCLUSIONS: In SPRINT, both higher nighttime and daytime BP were independently associated with higher hs-cTnT levels, but only higher nighttime BP was associated with higher NT-proBNP levels.

Periampullary Diverticula Causing Recurrent Pancreatitis: A Case Report.

Acute p-ancreatitis (AP) is increasingly rising globally, especially among elderly populations. In many cases, AP can progress to chronic pancreatitis (CP) and cause damage to the pancreas. Common causes of AP include gallstones and alcoholic injury, but periampullary diverticula (PAD) have emerged as a complex etiology. PADs are rare bowel-filled outpouchings located near the main papilla or common bile duct (CBD). In this study, we present a 66-year-old female with recurrent pancreatitis that is caused by a PAD. Due to the paucity of information regarding the management of PADs, we hope this case highlights the need to advance treatment options in this area.

Pediatric Heterotopic Ossification: A Comprehensive Review.

PURPOSE OF REVIEW: The purpose of this review is to provide a comprehensive analysis of heterotopic ossification (HO) in pediatric patients, including an in-depth examination of the risk factors associated with this condition, current prophylactic measures, and available management strategies. RECENT FINDINGS: HO is a medical disorder in which bone tissue inexplicably develops in soft tissues such as muscles and tendons. It involves the formation of mature, lamellar bone in extra-skeletal soft tissue, and its formation is influenced by oxygen tension, pH, the availability of micronutrients, and mechanical stimulation. HO has many cellular origins, with the most common theory being multipotent cells in local tissue. The diagnosis of HO is typically made based on exam, radiographs, and CT. Management includes both prophylactic nonsurgical options and surgical resection for severe or recalcitrant cases. The review highlights the incidence, risk factors, and management strategies associated with HO in pediatric patients. HO is a rare condition in children, with severe neurologic injury being the most common cause. Pediatric patients most commonly develop HO following severe neurologic injury, followed by trauma and surgery. Current prophylactic measures, include nonsteroidal anti-inflammatory drugs and radiation therapy though limited literature on their use in the pediatric population exists. For recalcitrant symptomatic cases, wide surgical resection can be considered but has a higher risk profile and associated morbidity. This review highlights the need for further pediatric specific research to inform guidelines and management strategies for this debilitating condition.

Case report: Development of vesicouterine and vesicovaginal fistulas after uterine rupture.

Vesicouterine fistulas are an extremely rare fistula occurring between the bladder and uterus and most commonly occur after lower segment cesarean sections. There are fewer than 100 case reports documenting vesicouterine fistulas, with most managed with open or laparoscopic surgical techniques. We present a novel case, including diagnostic evaluation and robotic-assisted repair, of a simultaneous vesicovaginal and vesicouterine fistula that developed after a uterine rupture that was complicated by multiple cystotomies. A robotic approach affords good visibility of the deep pelvis while still allowing for mobilization of the omentum as an interposition graft, with the benefit of a minimally-invasive approach.

Reverse Shoulder Arthroplasty in Nonagenarians - NIS-based study of perioperative and postoperative complications.

Purpose: Our aim is to investigate the length of stay (LOS), cost of care (COC) and postoperative complications associated with reverse shoulder arthroplasty (RSA) in nonagenarians (people aged 90-99 years old). Methods: We used the National Inpatient Sample (NIS) database to identify 59,925 patients who underwent RSA between 2016 and 2019, including 555 nonagenarians. We investigated the incidences of various medical and orthopedic postoperative complications in nonagenarians compared to their younger counterparts, as well as compared nonagenarians undergoing elective and non-elective surgery. Results: Nonagenarians were less likely admitted for elective surgery (69.9% in nonagenarians vs 92.8% in controls, p < 0.001) and were subject to longer LOS (3.5 days in nonagenarians vs 1.89 days in controls, p < 0.001) and greater COC ($91,794.69 US in nonagenarians vs $79,574.12 US in controls, p < 0.001). Nonagenarians had increased incidences of hospital mortality (0.72% in nonagenarians vs 0.06% in controls, p < 0.001), pneumonia (1.44% in nonagenarians vs 0.37% in controls, p < 0.001), blood loss anemia (22.34% in nonagenarians vs 10.12% in controls, p < 0.001), and ARF (6.85% in nonagenarians vs 2.18% in controls, p < 0.001). Nonagenarians undergoing elective RSA had fewer complications than those requiring non-elective RSA. Conclusion: Nonagenarians undergoing RSA are subject to increased LOS, COC, and postoperative complications. Despite this, we feel that the associated complications can be deemed acceptable and that with adequate preparation, the benefits of a successful RSA may outweigh the associated complications in elderly patients. This is important to aid clinicians and patients in making informed decisions for patient care and resource allocation, as well as highlights room for improvement in costs and hospital stay, as well as sheds light on persistent health disparities in orthopedic surgery. Level of evidence: IV.

Perioperative complications of legally blind patients undergoing total knee arthroplasty: A national inpatient sample database study.

Introduction: Vision impairment is a significant health concern that leads to increased morbidity and mortality globally. Significantly, legally blind (LB) patients have higher rates of hospitalization, cost, and orthopedic-related complications. Total knee arthroplasty (TKA) is commonly used to treat advanced knee osteoarthritis. However, there is limited literature reporting the demographic and hospitalization characteristics and operative outcomes of patients with LB who underwent TKA. This study addresses this gap in literature. Method: We conducted a retrospective study using a Nationwide Inpatient Sample database. We assessed perioperative complications, length of stay (LOS), and healthcare expenditure among legally blind and control cohort patients who underwent TKA. Propensity matching was conducted to identify factors associated with perioperative complications. Results: Between 2016 and 2020, there were 558,371 patients underwent TKA, with 0.1% of patients documented as legally blind. Of this cohort, the average age was significantly older than the control, 70.01 years versus 66.72 years (p < 0.001), respectively. Patients from the LB cohort had a longer length of stay (2.9 ± 1.7 days) than those from the control cohort (2.4 ± 1.3 days) (p < 0.001). Significantly, patients in the legally blind group incurred higher expenditures than those in the control group ($68,936 versus $64,808, respectively; p < 0.001). (Table 2). Propensity matching yields similar results. Analysis of TKA-associated operative complications suggested that legally blind patients had a higher proportion of blood loss anemia (20.97%, p < 0.05), required blood transfusions secondary to surgery (3.1%, p < 0.05), and periprosthetic fractures (2.6%, p < 0.05) than the control group (15.3%, 1.5%, and 0.42%, respectively). Conclusion: We report that LB patients are, on average, older and have an extended LOS, higher expenditure, and higher rates of specific TKA-associated operative complications than those without legal blindness. To date, this is the first study of its kind to provide large, population-based data on the demographics, costs, and TKA-operative complications in patients with LB and, as such, provides a purposeful basis for future research.

Perioperative complications of legally blind patients undergoing total hip arthroplasty - A national in-patient sample database study.

Background: Legally blind patients are more prone to injury-related falls, which may lead to hip fractures, often necessitating total hip arthroplasty (THA), as a corrective procedure. Many of these patients have unique medical needs and have increased rates of perioperative complications following surgical procedures. However, there is limited information on the hospitalization data and perioperative complications in this population following guidelines such as THA. The purpose of this study was to evaluate the patient characteristics, demographics, and prevalence of perioperative issues among THA patients who were legally blind. Methods: Using 2016-2019 data from the Nationwide Inpatient Sample (NIS), the incidence of perioperative complications, length of stay (LOS), and the cost of care (COC) among patients undergoing THA who were categorized as legally blind patients, compared to those who were not were analyzed. Propensity matching was conducted to consider associated factors that may influence perioperative complications. Results: From 2016 to 2019, 367,856 patients underwent THA, according to the NIS. Of those, 322 (0.1%) patients were categorized as legally blind, and the remaining 367,534 (99.9%) patients were not identified as legally blind (control). Legally blind patients were significantly younger than the control group (65.4 years vs. 66.7 years, p < 0.001). After propensity matching, legally blind patients had longer LOS (3.9 days vs. 2.8, p = 0.04), increased discharges to another facility (45.9% vs. 29.3%, p < 0.001), and fewer discharges to home (21.4% vs. 32.2%, p = 0.02) than control patients. Conclusions: The legally blind group had significantly longer LOS, higher rates of discharge to another facility, and lower rates of discharge to home compared to the control group. This data will help providers make informed decisions about patient care and resource allocation for legally blind patients undergoing THA.

Understanding factors that impact the length of stay after total hip arthroplasty - A national in-patient sample-based study.

Background: Total hip arthroplasty (THA) is increasingly used every year; however, there is currently limited information on factors that impact the length of stay (LOS) following the procedure. Longer LOS following THA is met with an increase in the cost of care, necessitating studies to identify factors that may impact LOS. Methods: In this retrospective study, we used the Nationwide Inpatient Sample (NIS) database from 2016 to 2019 to analyze the preoperative comorbidities and postoperative complications that impact the LOS following THA. We divided our cohort into patients with a LOS greater than two days, and patients with a LOS less than two days. Results: A total of 367,890 patients were identified in the NIS database who underwent THA during the study period. Of this cohort, 112,288 (30.52%) patients were identified as having a LOS greater than two days, while the remaining 255,602 (69.48%) patients were patients who had a LOS less than two days. Multivariate analysis demonstrated several pre-operative factors, such as diabetes, systemic lupus erythematosus, organ transplant, dialysis, the human immunodeficiency virus, chronic kidney disease, and Parkinson's disease, were independently associated with a higher risk of a LOS greater than two days. The subsequent multivariate analysis for post-operative variables demonstrated that acute renal failure, myocardial infarction, blood loss anemia, blood transfusion, pulmonary embolism, deep vein thrombosis, periprosthetic fracture, periprosthetic mechanical complications, periprosthetic infections, and wound dehiscence were all independently associated with a higher risk of a LOS greater than two days. Conclusions: Several pre-operative comorbidities and postoperative complications were found to increase the likelihood of a LOS greater than two days. In addition, the group with a LOS greater than two days incurred a higher cost of care. This information is useful for providers to make informed decisions regarding patient care and resource utilization for patients undergoing THA, potentially reducing LOS.

Factors that increase the rate of periprosthetic dislocation after reverse shoulder arthroplasty.

INTRODUCTION: Reverse shoulder arthroplasty (RSA) is considered one of the greatest technological innovations in shoulder reconstruction surgery, as evidenced by the fact its growth rate of usage is greatest among all shoulder arthroplasties. However, like all arthroplasties, a post-surgical complication often arises. One of these complications, periprosthetic dislocation (PPD), requires revision and poses, therefore, a burden on both patients and healthcare providers. While PPD is understood to be a complication of RSA, it is unclear to what extent certain risk factors and co-morbidities predispose patients to post-RSA PPD. The purpose of this study was to identify and evaluate the impact of specific risk factors and co-morbidities that contribute to the development of PPD following RSA. METHODS: In this retrospective study, we used the Nationwide Inpatient Sample (NIS) database from 2016-2019 to analyze the prevalence and impact of various risk factors and co-morbidities on the incidence of PPD following RSA. A univariate and subsequent multivariate logistic regression model was made to provide a descriptive association between variables that impact the rates of PPD after RSA. RESULTS: The NIS database identified 59,925 patients, 1,000 of whom experienced a PPD while the remaining 58,825 were placed in the non-PPD group (controls). The PPD group consisted predominantly of females (53.10%) and Caucasians (86.30%). There was a higher incidence of tobacco-related disorders (P = 0.003), obesity (P < 0.001), morbid obesity (P < 0.001), liver cirrhosis (P < 0.001), and Parkinson's disease (PD) (P < 0.001) in PPD patients compared to controls. Young patients had a 1.89-fold increased odds (OR: 1.89, 95% CI [1.58, 2.26], P < 0.001), patients with tobacco-related disorders had decreased odds (OR: 0.80, 95% CI [0.67, 0.97], P = 0.02), morbidly obese patients had 1.50 times the odds (OR: 1.50, 95% CI [1.14, 1.97]), liver cirrhosis patients had 2.67-fold increased odds (OR: 2.67, 95% CI [1.55, 4.60], P < 0.001), and Parkinson's disease patients had 2.66 times the odds (OR: 2.66, 95% CI [1.78, 3.96], P < 0.001) to develop PPD following RSA compared to patients who did not have the corresponding condition. CONCLUSIONS: Patients with specific risk factors and co-morbidities are predisposed to developing PPD after RSA. Risk factors that were found to be associated with a higher incidence of PPD are gender (female), race (Caucasian), and age (young patients). Analysis revealed the history of tobacco-related disorder, obesity, morbid obesity, liver cirrhosis, and Parkinson's disease increased the odds of developing PPD following RSA. These findings can inform both healthcare providers and patients to improve RSA surgical outcomes and tailor post-surgery recovery programs to fit the patient's needs.