The accuracy of hip fracture data entered into the national surgical quality improvement program (NSQIP) database.

PURPOSE: Internal validation studies of National Surgical Quality Improvement Program (NSQIP) registry data have reported potential inaccuracies. The purpose of this study was to determine the accuracy of hip fracture CPT codes and complications entered into NSQIP for a single participating center. METHODS: A retrospective study identified patients with a hip fracture CPT code from NSQIP data at a single institution over a two-year period. CPT codes included 27235 (percutaneous fixation of femoral neck fracture (Perc FNFX)), 27236 (open treatment of femoral neck fracture, internal fixation/prosthetic replacement (Open FNFX)), 27244 (open treatment of inter/peri/subtrochanteric femoral fracture with plate (Plate ITFX)), 27245 (treatment of inter/peri/subtrochanteric femoral fracture, with intramedullary implant (IMN ITFX)), and 27125 (hemiarthroplasty (HA)). The institutional medical record was reviewed to determine the accuracy of CPT code and 30-day complication data entered into the registry. RESULT: 12.8% (n = 20/156) of patients had an inaccurate CPT code. The proportion of inaccurate CPT codes varied significantly by procedure: Plate ITFX (76.9%), Open FNFX (13.8%), IMN ITFX (7.0%), and HA (0%) (p < 0.0001). A total of 82 complications were identified in 66 patients via the medical record. 43.9% (n = 36/82) of these complications were not documented in the NSQIP data. The proportion of missing complications varied significantly by type: renal (100%), UTI (53.8%), infection (50%), bleeding (30%), death (25%), respiratory (25%), cardiac (0%), stroke (0%), and VTE (0%) (p < 0.0001). CONCLUSION: Hip fracture CPT codes and 30-day complication data entered into the NSQIP registry were frequently inaccurate. Studies incorporating NSQIP data should acknowledge these potential limitations of the registry, and future research to validate NSQIP orthopedic data across procedures and institutions is necessary. LEVEL OF EVIDENCE: LEVEL III: Diagnostic study.

Incidence of Surgical Site Infections and Acute Kidney Injuries After Topical Antibiotic Powder Application in Orthopaedic Trauma Surgery.

OBJECTIVES: To compare the incidence of deep surgical site infections (SSI) and acute kidney injuries (AKI) in patients who did and did not receive topical antibiotics during the open treatment of fractures. DESIGN: Retrospective comparative cohort. SETTING: Level 1 trauma center. PATIENTS/PARTICIPANTS: Three hundred ninety-six patients undergoing open fixation of fractures. INTERVENTION: The topical antibiotic group included 78 (20%) patients. Vancomycin only was used in 28 (7%) patients with the median dose (interquartile range) of 1 g (1-2 g) and vancomycin/tobramycin was used in 48 (12%) patients with a median dose (interquartile range) of 2 g (1-2 g)/1.2 g (1.2-1.2 g). MAIN OUTCOME MEASUREMENTS: Deep SSI requiring debridement and AKI (>50% increase in creatinine compared with preoperative level). RESULTS: There was no detectable difference in SSI between the topical antibiotic and control groups (13% vs. 10%, odds ratio (OR) 1.3, 95% confidence interval (CI) 0.6 to 2.9). Variables associated with SSI on multivariate analysis included open fracture (OR 3.2, CI 1.5 to 6.5) and an American Society of Anesthesiologists classification of >2 (OR 2.7, CI 1.3 to 5.3). There was no detectable difference in AKI between the topical antibiotic and control groups (1 (2%) vs. 7 (5%); OR 0.3, CI 0.04 to 3). CONCLUSION: There was no detectable difference, with wide confidence intervals, in SSI and AKI between the topical antibiotic and control groups. Further studies need to be conducted to evaluate the relationship between topical antibiotics and clinical outcomes in orthopaedic trauma surgery. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Photoactivatable Prodrug of Doxazolidine Targeting Exosomes.

Natural lipid nanocarriers, exosomes, carry cell-signaling materials such as DNA and RNA for intercellular communications. Exosomes derived from cancer cells contribute to the progression and metastasis of cancer cells by transferring oncogenic signaling molecules to neighboring and remote premetastatic sites. Therefore, applying the unique properties of exosomes for cancer therapy has been expected in science, medicine, and drug discovery fields. Herein, we report that an exosome-targeting prodrug system, designated MARCKS-ED-photodoxaz, could spatiotemporally control the activation of an exquisitely cytotoxic agent, doxazolidine (doxaz), with UV light. The MARCKS-ED peptide enters a cell by forming a complex with the exosomes in situ at its plasma membrane and in the media. MARCKS-ED-photodoxaz releases doxaz under near-UV irradiation to inhibit cell growth with low nanomolar IC50 values. The MARCKS-ED-photodoxaz system targeting exosomes and utilizing photochemistry will potentially provide a new approach for the treatment of cancer, especially for highly progressive and invasive metastatic cancers.