December 20, 2019 | Today’s News

Study: Same-day Discharge after TJA May Increase Risk of Cardiac/Pulmonary Complications

Same-day discharge following total joint arthroplasty (TJA) could increase the risk for cardiac/pulmonary complications, according to a study published online in BMJ Open. Patients who underwent total knee arthroplasty (TKA, n = 226,481) or total hip arthroplasty (THA, n = 140,557) at one of 708 centers between 2011 and 2017 were stratified into three groups: length of stay (LOS), zero days; LOS, one day; and LOS, two to three days. Patients were excluded if LOS exceeded three days. Final analysis included: in the TKA group, LOS zero days, 3,118 patients; LOS one day, 31,404 patients; and LOS two to three days, 191,959 patients; and in the THA group, 2,652, 29,617, and 108,288 patients, respectively. No differences were observed in 30-day mortality. In adjusted analyses, LOS zero days, compared to LOS one day, was correlated with a greater risk for cardiac/pulmonary complications in TKA and THA patients. Unplanned readmissions did not differ between LOS zero days and LOS one day in TKA (2.41 percent versus 2.31 percent) and THA patients (1.62 percent versus 2.04 percent).

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Study Compares Shoulder Arthroplasty for Fracture versus OA

A study published in the Dec. 15 issue of the Journal of the AAOS compared total shoulder arthroplasty (TSA) patients treated for fracture versus osteoarthritis (OA) and how these differences may affect bundled payment models. Data were collected from the 2012 to 2016 American College of Surgeons–National Surgical Quality Improvement Program databases on TSA and reverse TSA patients with degenerative arthritis/OA (n = 8,283, 92.5 percent) or proximal humerus fracture (n = 667, 7.5 percent). In adjusted analyses, the fracture group was more likely to have LOS longer than two days; 30-day surgical complications, revision surgery, readmission, and medical complications; pulmonary embolism; postoperative transfusion; and nonhome discharge. The researchers concluded that TSA patients treated for fracture have higher resource utilization and recommended that this be taken into account as bundled payment models become more common.

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A retrospective study published online in Foot & Ankle International observed a high incidence of injuries to different anatomic sites and organ systems in patients with major fractures of the talus. Patients who presented at one of three level 1 trauma centers with talar neck, body, or head fracture were reviewed for associated orthopaedic and nonorthopaedic injuries during the initial presentation. Final analysis included 262 fractures (258 patients). A third of talus fractures were isolated; the remaining 66.7 percent of cases also presented at least one associated injury. Mean number of injuries per patient was 2.2. The most common associated orthopaedic injury occurred in the ipsilateral foot; 36 percent of cases presented noncontiguous injuries. Injury at the lumbar spine presented in 10.5 percent of cases. Lower-extremity vascular injury was infrequent but was correlated with open talus fractures.

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A retrospective study published in the Dec. 15 issue of Spine analyzed outcomes, perioperative complications, and prognostic factors associated with anterior cervical decompression and fusion (ACDF) in patients with cervical ossification of posterior longitudinal ligament (OPLL). Among 80 OPLL patients who underwent ACDF at a single institution between 1993 and 2013, 42 were available for at least five-year follow-up (mean, 7.9 years). The overall improvement rate was 59.2 percent. Twelve perioperative complications were reported in six patients, none of which were chronic. Upon multivariate logistic regression analysis, including preoperative Japanese Orthopaedic Association Score, OPLL type and occupying ratio, and the number of fused segments and increase in the transverse area of the cord, the only significant predictor of radiological and clinical improvement of more than 50 percent was the latter parameter. There were 16 patients with remaining ossified spinal lesions out of the decompressed range, of whom six presented postoperative progression, all of whom were of the mixed type. Progression during follow-up was not observed in floated lesions within the decompressed range. Nine patients presented adjacent segment degeneration, of whom three patients presented neurological signs and symptoms, and only one underwent revision surgery.

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A federal appeals court ruled that the individual mandate in the Affordable Care Act (ACA) is unconstitutional but deferred to a lower court to make a ruling on the rest of the law. It will be up to a Texas district court to determine whether the individual mandate can be considered a standalone from the rest of the ACA or if the entire law must be deemed unconstitutional

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All in the Family

Jennifer M. Weiss, MD, FAAOS, is the daughter of an orthopaedist and, as a second-generation orthopaedic surgeon, was well aware of all the women and men who come from orthopaedic families. Until recently, she knew of only father-daughter and father-son orthopaedic pairs. She took to social media hoping to find a mother-daughter dyad and found two: one American and one Canadian.

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The My Academy App Is Now Available for Free Download

Plan your personalized meeting experience with ease using the My Academy app. Log in using your AAOS credentials to access your personalized meeting content and build your education, exhibits, and networking agenda. The My Academy app is available for free download from the App Store and Google Play.

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