The literary hermeneutic of Rabbi Eliezer of Beaugency.

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Effect of Body Mass Index on Blood Transfusion in Total Hip and Knee Arthroplasty.

Perioperative blood management remains a challenge during total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of this study was to systematically examine the relationship between body mass index (BMI) and perioperative blood transfusion during THA and TKA while attempting to resolve conflicting results in previously published studies. The authors retrospectively evaluated 2399 patients, 896 of whom underwent THA and 1503 of whom underwent TKA. Various outcome variables were assessed for their relationship to BMI, which was stratified using the World Health Organization classification scheme (normal,/m(2); overweight, 25-30 kg/m(2); obese, \u3e30 kg/m(2)). Among patients undergoing THA, transfusion rates were 34.8%, 27.6%, and 21.9% for normal, overweight, and obese patients, respectively (P=.002). Among patients undergoing TKA, transfusion rates were 17.3%, 11.4%, and 8.3% for normal, overweight, and obese patients, respectively (P=.002). Patients with an elevated BMI have decreased rates of blood transfusion following both THA and TKA. This same cohort also loses a significantly decreased percentage of estimated blood volume. No trends were identified for a relationship between BMI and deep venous thrombosis, pulmonary embolism, myocardial infarction, discharge location, length of stay, 30-day readmission rate, and preoperative hemoglobin level. Elevated BMI was significantly associated with increased estimated blood loss in patients undergoing THA and those undergoing TKA. There was a statistically significant trend toward increased deep surgical-site infection in patients undergoing THA (P=.043). Patients with increased BMI have lower rates of blood transfusion and lose a significantly smaller percentage of estimated blood volume following THA and TKA. [Orthopedics.2016; 39(5):e844-e849.]

Hip Fracture Mortality: Differences Between Intertrochanteric and Femoral Neck Fractures

The purpose of this study was to identify the specific risk factors that affect mortality in patients with hip fractures and differentiate mortality-associated factors between intertrochanteric (IT) and femoral neck (FN) fractures. A total of 1538 consecutive patients with hip fractures were treated at the authors\u27 institution between January 2005 and October 2013. Ultimately 858 IT and 479 FN fracture patients were included on the basis of age \u3e60 years with an isolated hip fracture. Mortality rate at 90 days was 12.1% for IT and 9.6% for FN fractures. In both IT and FN fractures, variables associated with mortality risk include increased age, greater days to surgery, male gender, decreased body mass index, and increased American Society of Anesthesiologists score. When evaluated independently, the presence of cardiac arrhythmia and chronic kidney disease was strongly associated with greater mortality risk in FN fracture patients. The presence of chronic kidney disease and hypertension correlated with decreased mortality risk among FN fracture patients. (Journal of Surgical Orthopaedic Advances 27(1):64-71, 2018)