The role of preoperative aspartate aminotransferase-to-platelet ratio index in predicting complications following total hip arthroplasty.

BACKGROUND: The purpose of this study was to investigate the relationship between preoperative aspartate aminotransferase-to-platelet ratio index (APRI) and postoperative complications following total hip arthroplasty (THA). METHODS: All THA for osteoarthritis patients from 2007 to 2020 within the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database were included in this study. Subjects were subsequently divided into cohorts based on APRI. Four groups, including normal range, some liver damage, significant fibrosis, and cirrhosis groups, were created. Comparisons between groups were made for demographics, past medical history, and rate of major and minor complications. Other outcomes included readmission, reoperation, discharge destination, mortality, periprosthetic fracture, and postoperative hip dislocation. Multivariate logistic regression analysis was performed to determine the role of preoperative APRI in predicting adverse outcomes. Statistical significance was set at p < 0.05. RESULTS: In total, 104,633 primary THA patients were included in this study. Of these, 103,678 (99.1%) were in the normal APRI group, 444 (0.4%) had some liver damage, 256 (0.2%) had significant fibrosis, and 253 (0.2%) had cirrhosis. When controlling for demographics and relevant past medical history, the abnormal APRI groups had a significantly higher likelihood of major complication, minor complication, intraoperative or postoperative bleeding requiring transfusion, readmission, and non-home discharge (all p < 0.05) compared to normal APRI individuals. CONCLUSIONS: Abnormal preoperative APRI is linked with an increasing number of adverse outcomes following THA for osteoarthritis for patients across the United States. LEVEL OF EVIDENCE: Level I.

Cecal bascule: a systematic review of the literature.

BACKGROUND: Cecal volvulus is a rare clinical entity with an average incidence of 2.8-7.1 per million people per year, accounting for 1-2% of all large bowel obstructions. Cecal bascule is the rarest type of cecal volvulus, accounting for 5-20% of all cases. Although several case reports have been published, there is no consensus regarding its diagnosis and treatment. The aim of this study was to review the literature on cecal bascule in order to summarize the etiopathogenesis, clinical features, diagnosis, and treatment options. METHODS: The PubMed, MEDLINE, and Scopus databases were systematically searched by two independent authors. Cecal bascule was defined as anterior displacement of the distended cecum on the ascending colon without any torsion. The etiopathogenesis, clinical features, diagnosis, and treatment options were analyzed. RESULTS: Nineteen previously published papers reporting on 26 patients were included. The mean age of patients from previously reported cases was 55.1 ± 19.2 years, and 54% of all patients were males. Presenting symptoms included abdominal pain in 16 (61%), distension in 22 (84%), and vomiting in eight patients (30%). The mean time to diagnosis was 3.6 ± 2.6 days. The extent of surgery varied from cecopexy to right colectomy. There was no postoperative mortality. Cecal bascule recurred one 1 year after index surgery in one patient. CONCLUSIONS: Cecal bascule is a rare clinical entity, which is mostly encountered in patients with peritoneal adhesions, mobile cecum, bowel dysfunction, and cecal displacement. In patients with recurrent or persistent abdominal pain and distension, cecal bascule should be considered. The majority of these patients require surgical management.