The Relationship Between Cigarette Smoking and the Prevalence, Frequency and Severity of Back Pain.

The purpose of this study was to examine the relationship between smoking and back pain in a cross-sectional analysis. Using the Osteoarthritis Initiative database, a multi-center, longitudinal, observational cohort study with 4796 participants, we examined the prevalence of back pain and of limitations in activity due to back pain, as well as the frequency and severity of back pain in participants who were current smokers compared to those who had never smoked. Data was evaluated using binary and ordinal logistic regression analyses. An increase in prevalence, frequency and severity of back pain was strongly associated with smoking. This demonstrates a relationship between smoking and back pain; however, further studies are needed to evaluate causation. (Journal of Surgical Orthopaedic Advances 29(3):165-168, 2020).

The Incremental Cost of Inpatient Venous Thromboembolism After Hip Fracture Surgery.

OBJECTIVES: To (1) identify trends in the rates of deep venous thrombosis (DVT) and pulmonary embolism (PE) and (2) calculate the additional incremental inpatient cost and length of stay associated with venous thromboembolism (VTE) after hip fracture surgery. DESIGN: Retrospective database analysis. SETTING: Hospital discharge data. PATIENTS/PARTICIPANTS: A total of 838,054 patients undergoing operative treatment of hip fractures in the National Inpatient Sample from 2003 to 2014. INTERVENTION: Internal fixation or partial/total hip replacement. MAIN OUTCOME MEASURES: The length of stay and cost of hospitalization were compared between patients with VTE and those without using a Student t-test. A logistic regression model was performed to evaluate the trends in VTE rates, and a multivariable linear regression model was performed to evaluate inpatient hospital costs. RESULTS: The overall rates of DVT and PE were 0.3% and 0.53%, respectively. VTE was associated with an increased length of stay (9 days vs. 5 days) and increased inpatient cost ($103,860.83 vs. $51,576.00). The rate of DVT over the study period decreased, whereas the rate of PE increased. CONCLUSIONS: Each episode of VTE after hip fracture is a significant source of additional inpatient cost. Patients who sustain a VTE have approximately twice the length of stay and total inpatient cost compared with those who do not. The rates of DVT after hip fracture surgery are decreasing, whereas the rates of PE are increasing. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Chemoprophylaxis for the Hip Fracture Patient: A Comparison of Warfarin and Low-Molecular-Weight Heparin.

OBJECTIVE: To compare the rates of deep venous thrombosis (DVT), rates of pulmonary embolus (PE), and complication profiles of warfarin and low-molecular-weight heparin (LMWH) in patients undergoing operative fixation of hip fractures. DESIGN: Retrospective cohort study. SETTING: Insurance-based database of more than 22 million patient records. PATIENTS: Adult hip fracture patients who were treated operatively and received chemoprophylaxis from 2007 to 2016. A total of 7594 patients met inclusion criteria and were available for final analysis. INTERVENTION: Pharmacological anticoagulation with warfarin or LMWH to prevent postoperative venous thromboembolism after hip fracture surgery. MAIN OUTCOME MEASURES: Development of DVT or PE within 30 and 90 days of surgery. RESULTS: Patients prescribed warfarin had higher rates of DVT and PE compared with those prescribed LMWH. Patients on warfarin were more likely to develop a postoperative hematoma and to be readmitted within 30 and 90 days compared with those on LMWH. Patients in both groups had similar rates of total complications. CONCLUSIONS: Patients prescribed warfarin after hip fractures had higher rates of DVT and PE compared with those prescribed LMWH, although both agents had similar complication profiles. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.