Total Hip Arthroplasty: COPD and its Effect on Postoperative Complications

Introduction The demand for Total Hip Arthroplasty (THA) has rapidly risen and continues to due to high success rates of this procedure and the growing aging population. Particularly in Chronic Obstructive Pulmonary Disease (COPD), studies have indicated an increased risk of various postoperative complications across several surgery types. Despite the prevalence of COPD, very little has been investigated regarding postsurgical complications in patients with COPD following a THA. The aim of the current study is to utilize the NSQIP database and determine differences in short-term postoperative complications after undergoing THA, comparing patients with and without COPD. Methods In total, 74,814 patients were included in the analysis looking at how COPD contributes to the rates of postoperative complications in primary THA. Data was obtained from the National Surgical Quality Improvement Project Database years 2005-2014, with readmission/reoperation data beginning in 2011. THA cases were selected out of the database using current procedural terminology (CPT) code 27130. On univariate analysis, p-values were calculated using chi-square for categorical variables and one-way ANOVA for continuous variables. On multivariate analysis, logistic regression was used to control for preoperative comorbidities and calculate p-values. Results On multivariate analysis and after controlling for contributing comorbidities, having COPD was found to be an independent predictor of superficial surgical site infection (OR: 1.74), pneumonia (OR: 3.69), reintubation (OR: 2.65) failure to wean (OR: 3.45), urinary tract infection (OR: 1.46), needing a postoperative transfusion (OR: 1.19), and sepsis (OR: 1.97). COPD also independently predicted whether a patient would be discharged home or not (OR: 1.50). Discussion Although COPD has been linked to negative postoperative outcomes across several surgeries, few studies have examined postsurgical complications in patients with COPD following a THA. Our study found patients with COPD to have higher rates of superficial surgical site infection, pneumonia, reintubation, failure to wean, urinary tract infection, needing a postoperative transfusion, and sepsis. COPD also independently predicted whether a patient would be discharged home or not. Managing high-risk surgical patients requires a better understanding of possible complications a patient faces and enhancing perioperative conditions to improve outcomes. Given our study identified certain complications as independent risk factors for patients with COPD, surgeons and other healthcare providers can use this information to more accurately counsel patients and make perioperative adjustments accordingly

On \u3ci\u3eDistoma felineum\u3c/i\u3e Riv. in the United States and on the Value of Measurements in Specific Determinations among the Distomes (1895)

The distomes of cats have received special attention of late in the two papers of Braun (94) and stiles and Hassall (94). The latter authors give a most admirable account of our present knowledge of a dozen allied forms, and record two, D. albidum and D. complexum n. sp., as found in cats in the United States. During the past year I have examined the cats killed at this laboratory, and have found neither of the forms recorded from the east. Distoma felineum, however, which Stiles and Hassall did not find, and which has not been reported hitherto for the United States, is not uncommon here. Among a dozen cats examined last spring, two contained specimens of this species, and one of the four killed this fall was likewise infected. The first cat contained over one hundred of the distomes, and the others approximately one dozen each. The exact correspondence of the forms with the figures and descriptions of Braun and Stiles and Hassall leave little doubt as to the identity of the two forms, and yet there are some points of disagreement which deserve mention, especially since the discovery of the European form in the liver of man in Siberia by Winogradoff adds this species to the list of human parasites

Post-intensive care screening: French translation and validation of the Healthy Aging Brain Care-Monitor, hybrid version.

The Healthy Aging Brain Care-Monitor (HABC-M) questionnaires (self-reported version and caregiver version) have been validated for post-intensive care syndrome (PICS) detection in patients surviving a stay in the intensive care unit (ICU). Their authors have also developed a hybrid version (HABC-M-HV) suited to the daily needs of their post-ICU follow-up clinic. The objectives of the present cross-sectional observational study were to translate the HABC-M-HV questionnaire into French (HABC-M-HV-F) according to international guidelines and to test its measurement properties. The HABC-M-HV was translated according to international guidelines. The measurement performances of the questionnaire were tested using internal consistency, test-retest reliability, Standard Error of Measurement (SEM) and Smallest Detectable Change (SDC) calculation, floor and ceiling effect measurement and construct validity. The validation study included 51 ICU survivors (27.5% women, 63 [55-71] years old). The questionnaire was administered by phone. The internal consistency was very good (Cronbach's alpha coefficient 0.79). The intra- and inter-examinator reliabilities were excellent (Intraclass Coefficient Correlation = 0.99 and 0.97, respectively). The SEM was 0.62 and the SDC was 1.72. No floor or ceiling effects were observed. The convergent validity was almost entirely confirmed with 71.4% of our hypothesis confirmed. The HABC-M-HV-F has been shown to be a valid and reliable tool for PICS screening and follow-up in French-speaking ICU survivors. A remote administration by phone was feasible. Not applicable

Fixation and fusion

Spinal fixation represents the gold standard for the surgical treatment of a variety of diseases, including degenerative conditions, deformities, traumas, and tumors. The overall aims are to stop the degenerative process, to provide pain relief through stabilization, and often to promote a solid bony fusion. Fixation and fusion can be achieved by using a variety of approaches and devices, and understanding and managing the biomechanics behind each technique are crucial in determining a clinical treatment’s outcome. This chapter is divided into three sections that deal with pedicle screw fixation, posterolateral fusion, and fusion with intervertebral cages and bone grafts, in that order. In each section, the surgical technique is initially introduced with an explanation of its advantages and their clinical implications; an in-depth description of its biomechanical consequences follows with a discussion of each approach’s effect on spinal stability, kinematics, and load sharing. The state-of-the-art treatments are reviewed to provide a solid basis for understanding how the field of biomechanics is involved in the surgical treatments of degenerative disorders