Patient-Reported Outcomes of Total Hip Arthroplasty at an Ambulatory Surgery Center Versus a Hospital-Based Center.

INTRODUCTION: The utilization of ambulatory surgery centers (ASCs) and same-day discharge (SDD) from hospital-based centers (HBCs) after total hip arthroplasty (THA) continues to increase. There remains a paucity of literature directly comparing patient-reported outcomes by surgery site. We sought to compare outcomes between patients undergoing THA at an ASC versus HBC while controlling for medical comorbidities. METHODS: Patients undergoing primary THA with SDD (postoperative day 0) from a single HBC (1,015 patients) or stand-alone ASC (170 patients) from December 2020 to 2021 were identified. Patient demographics, comorbidities, and 90-day complications were collected. Hip Osteoarthritis Outcome Score (HOOS JR), VR-12, and procedural satisfaction scores were collected preoperatively and at 3, 6, and 12 months. Patients were matched by age and American Society of Anesthesiologists (ASA). Chi-squared analysis was conducted to compare categorical variables, and a Wilcoxon rank-sum test was used for continuous variables. Linear regression models were conducted considering age, sex, and presence of comorbidities. RESULTS: Patients undergoing THA at an ASC had markedly higher VR-12 Physical Component Scores at all time points and improved VR-12 Mental Component Scores at preoperative visit and 6 months. These patients had increased procedural satisfaction at 3 months, although there was no difference at 1 year. No notable difference was observed in 90-day complication rates between groups. After matching by age and ASA, each group had 170 patients. In the matched analysis, preoperative HOOS JR scores were markedly lower in the HBC group. However, there was no notable difference in HOOS JR scores, change in HOOS JR scores, and procedural satisfaction, at any postoperative time point. CONCLUSIONS: No notable difference was observed in patient-reported outcomes at any time point for SDD after THA performed at an ASC or an HBC when controlling for age and comorbidities. This study suggests noninferiority of stand-alone ASCs for outpatient THA, regarding patient satisfaction and patient-reported outcomes.

Measuring access to food banks and food pantries: A scoping review of spatial analysis approaches.

Food banks and food pantries are crucial in supporting access to food and addressing food insecurity for millions of people. This scoping review identified eighteen articles that applied spatial analysis approaches to measure access to food banks and food pantries. The review summarizes the methods and primary findings of these studies, and examines how these address different dimensions of food access. Findings suggest that the majority of studies measured the accessibility and availability dimensions of food access, and two addressed accommodation. Through a discussion of these studies' methods and broader literature on food environments, we highlight opportunities to integrate advanced geospatial and mixed methods to support an empirically grounded and broader understanding of food bank and pantry access in future research. This will yield a more holistic picture of food environments and provide practical implications for site selection, resource allocation, and food assistance operations.

Assessing changes in food pantry access after extreme events.

Food pantries play a growing role in supporting households facing or at risk of food insecurity in the United States. They also support emergency response and recovery following disasters and extreme weather events. Although food pantries are often placed in close proximity to communities with the highest rates of poverty and risk of food insecurity, access to these facilities can be disrupted during and after extreme events. Decreased access to food pantries following disasters can be particularly problematic as the need for these services is also likely to grow after such events. Despite the vast body of research on food retail access and food environments, relatively little research has utilized spatial analysis to understand food pantry access, particularly after extreme events. Using Geographic Information Systems (GIS), we characterize changes in access to food pantries following flooding events in Harris County, Texas-a highly populated and flood prone region with high levels of food insecurity and poverty. Specifically, our study models disruptions in road networks due to flooding and assesses the impacts of these disruptions on proximity to food pantries. The results reveal that much of Harris County sees only small increases in travel distance to food pantries due to extreme flooding, but some areas may be unable to access food pantries at all. This research highlights the potential and some of the limits of private food assistance networks to support emergency response efforts.

Optimization of tissue adhesive curing time for surgical wound closure.

AIMS: Tissue adhesives (TAs) are a commonly used adjunct to traditional surgical wound closures. However, TAs must be allowed to dry before application of a surgical dressing, increasing operating time and reducing intraoperative efficiency. The goal of this study is to identify a practical method for decreasing the curing time for TAs. METHODS: Six techniques were tested to determine which one resulted in the quickest drying time for 2-octyle cyanoacrylate (Dermabond) skin adhesive. These were nothing (control), fanning with a hand (Fanning), covering with a hand (Covering), bringing operating room lights close (OR Lights), ultraviolet lights (UV Light), or prewarming the TA applicator in a hot water bath (Hot Water Bath). Equal amounts of TA were applied to a reproducible plexiglass surface and allowed to dry while undergoing one of the six techniques. The time to complete dryness was recorded for ten specimens for each of the six techniques. RESULTS: Use of the Covering, OR Lights, and Hot Water Bath techniques were associated with a 25- (p = 0.042), 27- (p = 0.023), and 30-second (p = 0.009) reduction in drying time, respectively, when compared to controls. The UV Light (p = 0.404) and Fanning (p = 1.000) methods had no effect on drying time. CONCLUSION: Use of the Covering, OR Lights, and Hot Water Bath techniques present a means for reducing overall operating time for surgeons using TA for closure augmentation, which can increase intraoperative efficiency. Further studies are needed to validate this in vivo.Cite this article: Bone Jt Open 2022;3(8):607-610.

Clinical Outcomes following Biologically Enhanced Demineralized Bone Matrix Augmentation of Complex Rotator Cuff Repair.

Complex rotator cuff tears provide a significant challenge for treating surgeons, given their high failure rate following repair and the associated morbidity. The purpose of this study is to evaluate the clinical outcomes of patients who underwent biologically enhanced demineralized bone matrix augmentation of rotator cuff repairs. Twenty patients with complex rotator cuff tears underwent arthroscopic rotator cuff repair by a single surgeon with demineralized bone matrix (DBM) augmentation that was biologically enhanced with platelet-rich plasma and concentrated bone marrow aspirate. Post-operative MRI was used to determine surgical success. Patient reported outcome measures and range of motion data were collected pre-operatively and at the final post-operative visit for each patient. Ten patients (50%) with DBM augmentation of their arthroscopic rotator cuff repair were deemed non-failures. The failure group had less improvement of visual analogue pain scale (p = 0.017), Simple Shoulder Test (p = 0.032), Single Assessment Numerical Evaluation (p = 0.006) and abduction (p = 0.046). There was no difference between the groups for change in American Shoulder and Elbow Society score (p = 0.096), Constant-Murley score (p = 0.086), forward elevation (p = 0.191) or external rotation (p = 0.333). The present study found that 50% of patients who underwent biologically enhanced DBM augmentation of their rotator cuff repair demonstrated MRI-determined failure of supraspinatus healing.

Cervical and Lumbar Disc Arthroplasty: A Review of Current Implant Design and Outcomes.

While spinal disc pathology has traditionally been treated using fusion-based procedures, recent interest in motion-preserving disc arthroplasties has grown. Traditional spinal fusion is associated with loss of motion, alteration of native spine kinematics, and increased risks of adjacent segment disease. The motion conferred by disc arthroplasty is believed to combat these complications. While the first implant designs resulted in poor patient outcomes, recent advances in implant design and technology have shown promising radiographic and clinical outcomes when compared with traditional fusion. These results have led to a rapid increase in the utilization of disc arthroplasty, with rates of cervical arthroplasty nearly tripling over the course of 7 years. The purpose of this review was to discuss the evolution of implant design, the current implant designs utilized, and their associated outcomes. Although disc arthroplasty shows significant promise in addressing some of the drawbacks associated with fusion, it is not without its own risks. Osteolysis, implant migration, and the development of heterotopic ossification have all been associated with disc arthroplasty. As interest in these procedures grows, so does the interest in developing improved implant designs aimed at decreasing these adverse outcomes. Though they are still relatively new, cervical and lumbar disc arthroplasty are likely to become foundational methodologies for the treatment of disc pathology.

Bicortical suspensory button fixation yields greater ultimate load to failure over unicortical all-suture anchor fixation in distal biceps brachii tendon repair.

BACKGROUND: Various distal biceps tendon repair techniques exist, each with their own biomechanical profile. Recently, all-suture anchor fixation has recently become an intriguing option for distal biceps fixation, compared with the proven track record of the suspensory cortical button. In addition, intramedullary techniques have been utilized as a means to avoid complications such as nerve damage seen with extramedullary fixation. PURPOSE: The purpose of this study is to perform a comparative biomechanical analysis of 4 unique distal biceps tendon fixation methods: Unicortical/intramedullary all-suture anchor fixation (UIAS), Bicortical/extramedullary all-suture anchor fixation (BEAS), Unicortical/intramedullary suspensory button fixation (UISB), and Bicortical/extramedullary suspensory button fixation (BESB). STUDY DESIGN: Controlled Laboratory study. METHODS: 24 fresh-frozen cadaveric elbows were randomized into 4 groups providing data from 6 specimens, with each group undergoing a different repair technique. The specimens underwent 2 studies: Cyclic loading and Ultimate Load to failure (ULTF) testing. The repaired elbows were cycled 3000 times between 0 and 90 degrees of flexion, with displacement under cyclic loading at the repair site measured using a differential variable reductance transducer. ULTF test was performed with the elbow flexed at 90 degrees. The modes of failure were recorded. RESULTS: The mean cyclic displacements between the 4 groups were as follows: UIAS: 1.45 ± 1.04 mm; BEAS: 2.75 ± 1.32 mm; UISB: 1.45 ± .776 mm; BESB: 2.66 ± 1.18 mm (p= 0.077). Bicortical repairs displayed greater displacement after cyclic loading when compared with unicortical repairs regardless of anchor used (p= 0.007). The mean ULTF for each group was as follows: all-suture intramedullary: 200 N; all-suture extramedullary: 330 N; cortical-button intramedullary: 256 N; cortical-button extramedullary: 342 N). All-suture unicortical/intramedullary repair had a significantly lower ULTF (200 N) compared with cortical-button Bicortical/extramedullary repair (342 N) (p=0.043). CONCLUSION: Bicortical/extramedullary suspensory button fixation demonstrated a greater ultimate load to failure when compared with unicortical/intramedullary all-suture anchor fixation. These findings suggest that bicortical/extramedullary suspensory cortical button fixation is a biomechanically superior construct as compared to unicortical/intramedullary all-suture anchor fixation. However, there was no significant difference in ULTF between extra-medullary, Bicortical button or Bicortical, all-suture anchor fixation.

The impact of forest thinning on the reliability of water supply in central Arizona.

Economic growth in Central Arizona, as in other semiarid systems characterized by low and variable rainfall, has historically depended on the effectiveness of strategies to manage water supply risks. Traditionally, the management of supply risks includes three elements: hard infrastructures, landscape management within the watershed, and a supporting set of institutions of which water markets are frequently the most important. In this paper we model the interactions between these elements. A forest restoration initiative in Central Arizona (the Four Forest Restoration Initiative, or 4FRI) will result in thinning of ponderosa pine forests in the upper watershed, with potential implications for both sedimentation rates and water delivery to reservoirs. Specifically, we model the net effect of ponderosa pine forest thinning across the Salt and Verde River watersheds on the reliability and cost of water supply to the Phoenix metropolitan area. We conclude that the sediment impacts of forest thinning (up to 50% of canopy cover) are unlikely to compromise the reliability of the reservoir system while thinning has the potential to increase annual water supply by 8%. This represents an estimated net present value of surface water storage of $104 million, considering both water consumption and hydropower generation.