Evaluating Postoperative Immobilization Following Hip Reconstruction in Children With Cerebral Palsy

Objectives Currently, there is no standardized protocol for postoperative immobilization techniques in patients with cerebral palsy undergoing hip reconstructive procedures. The purpose of this study was to evaluate the effects of several methods of postoperative immobilization and to determine which postoperative immobilization technique has the fewest complications. Materials and methods A retrospective cohort study of pediatric patients with cerebral palsy who underwent hip reconstructive procedures, in which a hip spica cast, Petrie cast, or abduction pillow was placed for postoperative hip immobilization, was conducted. Patients who underwent revision surgery and those without cerebral palsy were excluded from the analysis. The final cohort consisted of 70 cases. Demographics, laterality of surgery, procedure type, hip immobilization technique, and 30-day postoperative complications were recorded. Complications were defined as those related to casting immobilization, such as re-dislocation or loss of surgical fixation, and soft tissue complications, such as pressure ulcers or any superficial or deep wound infection. Results Of the 70 patients, 27 received spica casting, 28 received Petrie casting, and 15 received an abduction pillow. The complication rates, as defined in the methods section, were 14.8% for the spica cast group, 17.9% for Petrie cast, and 26.7% for abduction pillow. There was no significant difference in complication rates among spica cast, Petrie cast, or abduction pillow groups (P=0.76). Conclusions There was no significant difference in length of stay, pain control duration, or complication rates among the three methods of immobilization. Clinicians should be advised of the comparable outcomes among the postoperative immobilization techniques

Metabolic Syndrome: Is Arthroscopic Rotator Cuff Repair Safe in This Patient Population?

Purpose Metabolic syndrome is associated with postoperative morbidity and mortality in surgical patients. With the increased use of arthroscopic techniques for rotator cuff repair (RCR), it is important to identify the impact this disorder has on surgical patients. The purpose of this study is to evaluate the clinical impact of metabolic syndrome on outcomes following arthroscopic RCR. Methods The 2006-2019 National Surgical Quality Improvement Program database was queried for adult patients who underwent arthroscopic RCR. Two patient groups were categorized: patients with metabolic syndrome and patients without metabolic syndrome. Demographics, comorbidities, and 30-day postoperative outcomes were compared using bivariate and multivariate analyses. Results Of 40,156 patients undergoing arthroscopic RCR, 36,391 did not have metabolic syndrome and 3,765 had metabolic syndrome. After adjusting for differences in baseline characteristics between the two groups, those with metabolic syndrome had an increased risk of developing renal complications and cardiac complications, as well as requiring hospital admission postoperatively and hospital readmission. Conclusion Metabolic syndrome is an independent risk factor for developing renal and cardiac complications, as well as requiring overnight hospital admission and hospital readmission. Providers should understand the need for preoperative evaluation and surveillance of these patients following their surgery to minimize the risk of poor outcomes

Correction: Evaluating Postoperative Immobilization Following Hip Reconstruction in Children With Cerebral Palsy

[This corrects the article DOI: 10.7759/cureus.30270.]

The association between anesthesia type and postoperative outcomes in patients receiving primary total shoulder arthroplasty

PURPOSE: There has been interest to investigate optimal anesthetic techniques for primary total shoulder arthroplasty (TSA). In this study, we investigate if there are differences in postoperative complications in patients receiving (1) regional alone; (2) general alone; and (3) regional plus general anesthesia for primary TSA. METHODS: Patients undergoing primary TSA from 2014 to 2018 were identified in a national database. Patients were stratified into 3 cohorts: general anesthesia, regional anesthesia, and general anesthesia combined with regional anesthesia. Thirty-day complications were assessed using bivariate and multivariate analyses. RESULTS: Of 13,386 total patients undergoing TSA, 9079 patients (67.8%) had general anesthesia, 212 (1.6%) had regional anesthesia, and 4095 (30.6%) had general anesthesia combined with regional anesthesia. There were no significant differences in postoperative complications between the general anesthesia group and the regional anesthesia group. Following adjustment, an increased risk of extended length of hospital stay was seen in the combined general and regional anesthesia group compared to those who only had general anesthesia (p = 0.001). CONCLUSION: General versus regional versus general plus regional anesthesia have no difference in postoperative complications in patients receiving primary total shoulder arthroplasty. However, addition of regional anesthesia to general anesthesia is associated with increased length of stay. LEVEL OF EVIDENCE: III

Reintervention Rate After Pigtail Catheter Insertion Compared to Surgical Chest Tubes

BACKGROUND: Prior studies suggest similar efficacy between large-bore chest tube (CT) placement and small-bore pigtail catheter (PC) placement for the treatment of pleural space processes. This study examined reintervention rates of CT and PC in patients with pneumothorax, hemothorax, and pleural effusion. METHODS: This retrospective study examined patients from September 2015 through December 2020. Patients were identified using ICD codes for pneumothorax, hemothorax, or pleural effusion. Use of a pigtail catheter (≤14Fr) or surgical chest tube (≥20Fr) was noted. The primary outcome was overall reintervention rate within 30 days of tube insertion. Patients who died with a pleural drainage catheter in place, unrelated to complications from chest tube placement, were excluded. RESULTS: There were 1032 total patients in the study: 706 CT patients and 326 PC patients. The PC group was older with more comorbidities and more likely to have effusion as the indication for pleural drainage. Patients with PC were 2.35 times more likely to have the tube replaced or repositioned ( \u3c .0001), 1.77 times more likely to require any reintervention ( = .001) and 2.09 times more likely to remain in the hospital \u3e14 days ( \u3c .0001) compared to patients with CT. CONCLUSION: PCs have a significantly higher reintervention rate compared to CT for the treatment of pneumothorax, hemothorax, and pleural effusion. Although PC are believed to cause less pain and tissue trauma, they do not necessarily drain the pleural space as well as CT. Decisions on which method of draining the chest should be made on a case-by-case basis