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Orthop Clin North Am ; 51(2): 235-239, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32138861


To determine if orthopedic surgeons are more efficient than nonsurgical providers at care of operative injuries in walk-in clinics, patients in a walk-in clinic for evaluation of acute injury who subsequently had surgical treatment of isolated distal radial fracture were compared based on whether the initial visit was with a surgical or nonsurgical provider. Initial evaluation in a walk-in orthopedic clinic setting versus a conventional hand surgeon's clinic was associated with longer delay between initial evaluation and surgical treatment, but this difference may not be significant. Evaluation by a nonsurgical provider was not associated with increased duration to definitive treatment.

Fraturas do Rádio/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , Instituições de Assistência Ambulatorial , Feminino , Fixação Interna de Fraturas , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas do Rádio/terapia , Tempo para o Tratamento , Adulto Jovem
JBJS Case Connect ; 9(1): e18, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30920997


CASE: An immunosuppressed 51-year-old man sustained a ballistic injury about the site of a primary total hip arthroplasty, which had been performed for osteonecrosis of the femoral head 2 years earlier. He was treated with arthroscopic debridement and irrigation, inspection of the implants, and removal of foreign bodies. CONCLUSION: Ballistic injury to a hip arthroplasty site with retained foreign bodies is an unusual injury. Hip arthroscopy may represent a minimally invasive treatment option for implant inspection, joint debridement, and removal of intra-articular fragments while minimizing the risk of soft-tissue complications.

J Shoulder Elbow Surg ; 28(1): 65-70, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30100176


BACKGROUND: Outpatient total shoulder arthroplasty (TSA) is increasing in frequency, but the selection of patients who are appropriate outpatient joint candidates remains challenging. We propose an algorithm for selecting outpatient TSA candidates, with validation by a cohort of patients from an ambulatory surgery center (ASC). METHODS: We identified 61 patients who had primary anatomic and reverse TSA. The selection algorithm, which stratifies patients referable to their age and cardiopulmonary comorbidities, was used to choose patients for outpatient surgery. Complications, including cardiopulmonary, thromboembolic, and postoperative wound problems, were recorded. RESULTS: All 61 patients were discharged from the ASC on the day of surgery. There were no cardiopulmonary events requiring intervention or hospital admission. One patient (2%) required a secondary operation, 3 patients (5%) experienced acute surgical complications, 3 patients (5%) had transient postoperative nausea, and 4 patients (7%) had additional complications within the 90-day episode of care. CONCLUSIONS: This study is the first to propose a patient selection method for outpatient TSA. Using this algorithm for patient selection produced a low rate of perioperative complications and no hospital admissions. We suggest this algorithm provides an evidence-based method for the standardization of outpatient TSA candidate selection.

Algoritmos , Procedimentos Cirúrgicos Ambulatórios , Artroplastia do Ombro , Seleção de Pacientes , Adulto , Idoso , Estudos de Coortes , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade
J Arthroplasty ; 33(1): 46-50, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28927566


BACKGROUND: We proposed to determine the complication and hospital admission rates for patients with total hip arthroplasty (THA) done by a single surgeon in a stand-alone ambulatory surgical center with same-day discharge. Given the recent emphasis on bundled payments for a 90-day episode of care, this same time frame after surgery was chosen to determine patient outcomes. METHODS: The records of patients with THAs done through a direct anterior approach by a single surgeon at 2 separate ambulatory surgery centers were reviewed. To analyze the learning curve for outpatient THA, the procedures were arbitrarily divided into 2 groups depending on when they were done: early in our experience or later. Complications were recorded, as were hospital admissions and surgical interventions, length of surgery and blood loss, and time spent at the outpatient facility. RESULTS: Over a 3-year period, 145 outpatient THAs were done in 125 patients; 73 were considered to be initial procedures, and 72 were considered to be later procedures. Only one of the 145 procedures (0.7%) required transfer from the outpatient facility to the hospital for a blood transfusion. No other direct admissions to the hospital or transfers to the emergency department from the surgery center were necessary. Surgical interventions were required after 3 (2%) of the 145 arthroplasties in the global period (90 days). CONCLUSION: This study demonstrated that same-day discharge to home following THA can be safely done without increased complications, readmissions, reoperations, or emergency room visits.

Instituições de Assistência Ambulatorial/estatística & dados numéricos , Artroplastia de Quadril/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Artroplastia de Quadril/estatística & dados numéricos , Transfusão de Sangue , Hospitalização , Humanos , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Alta do Paciente , Complicações Pós-Operatórias/etiologia , Reoperação , Tennessee/epidemiologia
J Arthroplasty ; 31(8): 1620-4, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27143019


Obesity is a problem that is increasing in prevalence in the United States and in other countries, and it is a common comorbidity in patients seeking total joint arthroplasty for degenerative musculoskeletal diseases. Obesity, as well as commonly associated comorbidities such as diabetes mellitus, cardiovascular disease, and those contributing to the diagnosis of metabolic syndrome, have been shown to have detrimental effects on total joint arthroplasty outcomes. Although there are effective surgical and nonsurgical interventions which can result in weight loss in these patients, concomitant benefit on arthroplasty outcomes is not clear. Preoperative optimization of surgical risk in obese total joint arthroplasty patients is an important point of intervention to improve arthroplasty outcomes.

Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Obesidade/epidemiologia , Osteoartrite do Quadril/cirurgia , Osteoartrite do Joelho/cirurgia , Cuidados Pré-Operatórios/normas , Artroplastia de Quadril/estatística & dados numéricos , Artroplastia do Joelho/estatística & dados numéricos , Cirurgia Bariátrica , Comorbidade , Diabetes Mellitus/epidemiologia , Humanos , Síndrome Metabólica/epidemiologia , Obesidade/terapia , Osteoartrite do Quadril/epidemiologia , Osteoartrite do Joelho/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Prevalência , Fatores de Risco , Estados Unidos/epidemiologia , Programas de Redução de Peso