Preoperative International Normalized Ratio Thresholds in Hip Fracture: An Analysis of the National Surgical Quality Improvement Program

Background: Hip fractures are one of the most common orthopaedic injuries among the elderly, and as life expectancy continues to rise, the incidence of hip fractures has increased. The international normalized ratio (INR) is routinely obtained preoperatively to assess a patient’s readiness for surgery to evaluate bleeding risk. We aimed to 1) assess the relationship between preoperative INR in hip fracture patients and postoperative complication rates and 2) establish an INR threshold under which patients would be safe to proceed to surgery without INR correction. Methods: We retrospectively reviewed cases of hip fracture surgical stabilization in the American College of Surgeons National Surgical Quality Improvement Program from January 1, 2012 to December 31, 2018. Cases were stratified into four groups based on preoperative INR levels: 1) \u3c 1.4, 2) ≥1.4 and Results: Thirty-five thousand nine hundred-ten cases were identified, with 33,484 (93.2%) performed on patients with preoperative INR \u3c 1.4, 867 (2.4%) on INR ≥1.4 and Conclusions: In this study we found a threshold of INR\u3c 1.6 to be safe for patients prior to undergoing hip fracture surgery. Below this value patients avoid an increased risk of both transfusions and 30-day mortality seen at higher INR values. These findings may allow for adjustments to preoperative protocols and improve outcomes of hip fracture surgery in this population

A Simultaneous Dual-site Technosignature Search Using International LOFAR Stations

The Search for Extraterrestrial Intelligence aims to find evidence of technosignatures, which can point toward the possible existence of technologically advanced extraterrestrial life. Radio signals similar to those engineered on Earth may be transmitted by other civilizations, motivating technosignature searches across the entire radio spectrum. In this endeavor, the low-frequency radio band has remained largely unexplored; with prior radio searches primarily above 1 GHz. In this survey at 110-190 MHz, observations of 1,631,198 targets from TESS and Gaia are reported. Observations took place simultaneously with two international stations (noninterferometric) of the Low Frequency Array in Ireland and Sweden. We can reject the presence of any Doppler drifting narrowband transmissions in the barycentric frame of reference, with equivalent isotropic radiated power of 10 17 W, for 0.4 million (or 1.3 million) stellar systems at 110 (or 190) MHz. This work demonstrates the effectiveness of using multisite simultaneous observations for rejecting anthropogenic signals in the search for technosignatures.Comment: 15 Pages, 16 Figures, 2 Machine Readable Table

Longitudinal observation and decline of neutralizing antibody responses in the three months following SARS-CoV-2 infection in humans

Antibody responses to SARS-CoV-2 can be detected in most infected individuals 10–15 d after the onset of COVID-19 symptoms. However, due to the recent emergence of SARS-CoV-2 in the human population, it is not known how long antibody responses will be maintained or whether they will provide protection from reinfection. Using sequential serum samples collected up to 94 d post onset of symptoms (POS) from 65 individuals with real-time quantitative PCR-confirmed SARS-CoV-2 infection, we show seroconversion (immunoglobulin (Ig)M, IgA, IgG) in >95% of cases and neutralizing antibody responses when sampled beyond 8 d POS. We show that the kinetics of the neutralizing antibody response is typical of an acute viral infection, with declining neutralizing antibody titres observed after an initial peak, and that the magnitude of this peak is dependent on disease severity. Although some individuals with high peak infective dose (ID50 > 10,000) maintained neutralizing antibody titres >1,000 at >60 d POS, some with lower peak ID50 had neutralizing antibody titres approaching baseline within the follow-up period. A similar decline in neutralizing antibody titres was observed in a cohort of 31 seropositive healthcare workers. The present study has important implications when considering widespread serological testing and antibody protection against reinfection with SARS-CoV-2, and may suggest that vaccine boosters are required to provide long-lasting protection

Predictors and Outcomes of Postoperative Hemoglobin of \u3c8 g/dL in Total Joint Arthroplasty.

BACKGROUND: Restrictive transfusion practices have decreased transfusions in total joint arthroplasty (TJA). A hemoglobin threshold of/dL is commonly used. Predictors of this degree of postoperative anemia in TJA and its association with postoperative outcomes, independent of transfusions, remain unclear. We identified predictors of postoperative hemoglobin of/dL and outcomes with and without transfusion in TJA. METHODS: Primary elective TJA cases performed with a multimodal blood management protocol from 2017 to 2018 were reviewed, identifying 1,583 cases. Preoperative and postoperative variables were compared between patients with postoperative hemoglobin of≥8 g/dL. Logistic regression and receiver operating characteristic curves were used to assess predictors of postoperative hemoglobin of/dL. RESULTS: Positive predictors of postoperative hemoglobin of/dL were preoperative hemoglobin level (odds ratio [OR] per 1.0-g/dL decrease, 3.0 [95% confidence interval (CI), 2.4 to 3.7]), total hip arthroplasty (OR compared with total knee arthroplasty, 2.1 [95% CI, 1.3 to 3.4]), and operative time (OR per 30-minute increase, 2.0 [95% CI, 1.6 to 2.6]). Negative predictors of postoperative hemoglobin of/dL were tranexamic acid use (OR, 0.42 [95% CI, 0.20 to 0.85]) and body mass index (OR per 1 kg/m2 above normal, 0.90 [95% CI, 0.86 to 0.94]). Preoperative hemoglobin levels of CONCLUSIONS: Postoperative hemoglobin of/dL after TJA was associated with worse outcomes, even for patients who do not receive transfusions. Optimizing preoperative hemoglobin levels may mitigate postoperative anemia and adverse outcomes. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence

Determining a preoperative international normalised ratio threshold safe for hip fracture surgery.

INTRODUCTION: The purpose of this study was first, to assess the relationship between preoperative INR (international normalised ratio) and postoperative complication rates in patients with a hip fracture, and second, to establish a threshold for INR below which the risk of complications is comparable to those in patients with a normal INR. METHODS: We retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program and found 35,910 cases who had undergone surgery for a hip fracture between 2012 and 2018. Cases were stratified into 4 groups based on their preoperative INR levels: \u3c1.4; ⩾1.4 and \u3c1.6; ⩾1.6 and \u3c1.8 and ⩾1.8. These cohorts were assessed for differences in preoperative factors, intraoperative factors, and postoperative course. Multivariate logistic regression was used to assess the risk of transfusion, 30-day mortality, cardiac complications, and wound complications adjusting for all preoperative and intraoperative factors. RESULTS: Of the 35,910 cases, 33,484 (93.2%) had a preoperative INR \u3c 1.4; 867 (2.4%) an INR ⩾1.4 and \u3c1.6; 865 (2.4%) an INR ⩾ 1.6 and \u3c1.8 and 692 (1.9%) an INR ⩾ 1.8. A preoperative INR ⩾ 1.8 was independently associated with an increased risk of bleeding requiring transfusion. A preoperative INR ⩾ 1.6 was associated with an increased risk of mortality. CONCLUSIONS: We found that an INR of \u3c1.6 is a safe value for patients who are to undergo surgery for a hip fracture. Below this value, patients avoid an increased risk of both transfusion and 30-day mortality seen with higher INR values. These findings may allow adjustment of preoperative protocols and improve the outcome of hip fracture surgery in this group of patients

Development and Testing of an Expectations Survey for Patients Undergoing Foot and Ankle Surgery

Category: Other Introduction/Purpose: Functional outcomes scores routinely used in orthopedic research are limited in that they are developed solely from a surgeon’s perspective. Very few studies have investigated patients’ expectations from foot and ankle surgery. Many authors have reported on patient satisfaction, but rarely on expectations, which may vary widely between patients and even strongly affect satisfaction. In this cross-sectional study, we aimed to develop and test a patient-derived expectations survey for patients undergoing foot and ankle surgery. Methods: Using a three-phase process, we developed and tested a patient-derived expectations survey. Patients with a wide spectrum of foot and ankle diagnoses were enrolled, including the major diagnoses of ankle arthritis, ankle instability, ankle osteochondral lesions, flatfoot deformity, hallux valgus, and hallux rigidus. In phase 1, patients were interviewed preoperatively with open-ended questions about their expectations from surgery. Responses were independently assessed by three reviewers using qualitative techniques. Major concepts were grouped into categories which were used to form a draft survey. In phase 2, the survey was administered to preoperative patients on two occasions to establish test-retest reliability. In phase 3, the final survey items were selected based on weighted kappa values for response concordance and clinical relevance, and a scoring rubric was developed. Results: In phase 1, 94 preoperative patients with diverse foot or ankle pathology (mean age 50 ± 15 years, 63% women) volunteered 655 expectations. 29 representative categories were discerned by qualitative analysis and became the draft survey. In phase 2, another 60 patients (mean age 55 ± 15 years, 60% women) completed the draft survey twice preoperatively, separated by an average of 4 days. In phase 3, 23 items were retained for the final survey. For retained items, the average weighted kappa value was 0.54 (Table). An overall score is calculated based on the number of expectations and the amount of improvement expected and ranges from 0-100, with higher scores indicating more expectations. For patients in phase 2, mean scores for both administrations were 65 and 66 and approximated normal distributions. Cronbach alpha coefficients were 0.88 and 0.90, and the intraclass correlation coefficient between scores was 0.78. Conclusion: We developed a patient-derived survey specific to foot and ankle surgery that is valid, reliable, and applicable to diverse diagnoses. It measures physical as well as psychological expectations, encompassing symptoms, function, mobility, work and social activities, exercise/sports, pain medications, shoewear, and appearance. The survey generates an overall score that is easy to calculate and interpret, and thus offers a practical and comprehensive way to record patients’ expectations. In the future, this survey may be used as a means to assess patient satisfaction with surgery as determined by the fulfillment of their expectations

Association between changes in molecular biomarkers of cartilage matrix turnover and changes in knee articular cartilage : a longitudinal pilot study

Background: An early detection of Osteoarthritis is urgently needed and still not possible until today. The aim of the study was to assess whether molecular biomarkers of cartilage turnover are associated with longitudinal change in knee cartilage thickness during a 2 year period in individuals with increased risk of developing knee osteoarthritis. A secondary aim was to assess whether prior knee injury or subjective patient-reported outcomes at baseline (BL) were associated with articular cartilage changes. Nineteen volleyball players (mean age 46.5 ± 4.9 years, 47% male) with a 30-year history of regular high impact training were recruited. The serum biomarkers Cpropeptide of type II procollagen (CPII), cartilage oligomeric matrix protein (COMP), collagenase generated carboxy-terminal neoepitope of type II collagen (sC2C), cartilage intermediate layer protein 2 (CILP-2), and the urine biomarkers C-telopeptide of type II collagen (CTX-II) and collagenase-generated peptide(s) of type II collagen (C2C-HUSA) were assessed at BL and at 2 year follow up (FU). Femorotibial cartilage thinning, thickening and absolute thickness change between BL and FU was evaluated from magnetic resonance imaging. Subjective clinical status at BL was evaluated by the International Knee Documentation Committee Subjective Knee Form and the Short-Form 36 Physical Component Score. Results: CILP-2 was significantly higher at FU and linearly associated with the absolute cartilage thickness change during the experimental period. Prior injury was a predictor of increased absolute cartilage thickness change. Conclusion: Measuring the change in the cartilage biomarker CILP-2 might be a valid and sensitive method to detect early development of knee osteoarthritis as CILP-2 appears to be related to cartilage thickness loss in certain individuals with increased risk of developing knee osteoarthritis. Prior knee injury may be predictive of increased articular cartilage thickness change