The Impact of Metabolic Syndrome and Obesity on Perioperative Total Joint Arthroplasty Outcomes: The Obesity Paradox and Risk Assessment in Total Joint Arthroplasty

Background: The relationship between elevated body mass index (BMI) and adverse outcomes in joint arthroplasty is well established in the literature. This paper aims to challenge the conventional thought of excluding patients from a total knee or hip replacement based on BMI alone. Instead, we propose using the metabolic syndrome (MetS) and its defining components to better identify patients at high risk for intraoperative and postoperative complications. Methods: Patients who underwent primary, elective total knee and total hip arthroplasty were identified in the 2015-2020 American College of Surgeons National Surgical Quality Improvement Program database. Several defining components of MetS, such as hypertension, diabetes, and obesity, were compared to a metabolically healthy cohort. Postoperative outcomes assessed included mortality, length of hospital stay, 30-day surgical and medical complications, and discharge. Results: The outcomes of 529,737 patients from the American College of Surgeons National Surgical Quality Improvement Program who underwent total knee and total hip arthroplasty were assessed. MetS is associated with increased complications and increased mortality. Both hypertension and diabetes are associated with increased complications but have no impact on mortality. Interestingly, while obesity was associated with increased complications, there was a significant decrease in mortality. Conclusions: Our results show that the impact of MetS is more than the sum of its constitutive parts. Additionally, obese patients experience a protective effect, with lower mortality than their nonobese counterparts. This study supports moving away from strict BMI cutoffs alone for someone to be eligible for an arthroplasty surgery and offers more granular data for risk stratification and patient selection

Rates and Characteristics of Patients Leaving against Medical Advice after Spine Surgery

Introduction: Leaving against medical advice (AMA) has been associated with higher rates of readmission and worse postoperative outcomes in various surgical fields. Patients who have undergone spine surgery often require careful postoperative follow-up to ensure an uncomplicated recovery. In this study, we aim to investigate the demographic and hospital variables that may have contributed to patients leaving the hospital AMA following spine surgery. Methods: We performed a retrospective analysis of patients receiving spine surgery; we used the data from the Healthcare Cost and Utilization Project (HCUP) database for the years 2011-2020. Demographics, household income status, insurance status, time from admission to operation, length of stay, length of recovery, and discharge disposition were collected and analyzed. Multivariate linear regression was used to determine the odds ratios of each factor and their association to patient decision of leaving AMA. Results: As per our findings, patients aged 30-49 had 1.666 times greater odds of leaving AMA following spine surgery (P<0.001), patients aged 50-64 had 1.222 times greater odds of leaving AMA (P=0.001), and patients older than 65 had 0.490 times lesser odds of leaving AMA (P<0.001). Additionally, black patients were 1.612 times more likely to leave AMA (P<0.001), whereas white patients were 0.675 times less likely to do so (<0.001). Women were 0.555 times less likely to leave AMA than the rest of the population (P<0.001). Moreover, patients with private insurance were 0.268 times less likely to leave AMA (P<0.001), while patients on Medicare and Medicaid were 1.692 times (P<0.001) and 3.958 times more likely to leave AMA (P<0.001) following spine surgery, respectively. Finally, patients in the lowest quartile of income were 1.691 times more likely to leave AMA (P<0.001), while patients in the higher quartile of income were 0.521 times less likely to do so (P<0.001). Conclusions: It is critical that spine surgeons are aware of the factors that predispose patients to leave AMA in order to mitigate postoperative complications

Additional file 2: Figure S1. of Granulocyte colony-stimulating factor (G-CSF) promotes spermatogenic regeneration from surviving spermatogonia after high-dose alkylating chemotherapy

Seminiferous tubule diameters of animals in Experiments 2 and 3. Results are from mice in (A) Experiment 2 and (B) Experiment 3. Round seminiferous tubules were defined as having a shape factor of ≥0.8 (shape factor = 4πarea/circumference2), where a value closer to 1 is a more perfect circle. Morphometrics were reported for only seminiferous tubule cross-sections containing complete spermatogenesis. Shown are tubule equivalent diameters (equivalent diameter = √(4area/π) which provides the diameter of a circle with the equivalent area as the noted tubule cross-section. All values are average ± SEM. Labels above bars signify statistically-significant differences between groups as determined by student’s t-test (* p <0.001 control vs. G-CSF; ** p <0.01 control vs. Busulfan and/or Busulfan + G-CSF). (PDF 406 kb

A modified frailty index predicts complication, readmission, and 30-day mortality following the revision total hip arthroplasty

Abstract Introduction This study aimed to develop a modified frailty index (MFI) to predict the risks of revision total hip arthroplasty (THA). Methods Data from the American College of Surgeons - National Surgical Quality Improvement Program were analyzed for patients who underwent revision THA from 2015 to 2020. An MFI was composed of the risk factors, including severe obesity (body mass index > 35), osteoporosis, non-independent function status prior to surgery, congestive heart failure within 30 days of surgery, hypoalbuminemia (serum albumin < 3.5), hypertension requiring medication, type 1 or type 2 diabetes, and a history of chronic obstructive pulmonary disease or pneumonia. The patients were assigned based on the MFI scores (MFI0, no risk factor; MFI1, 1–2 risk factors; MFI2, 3–4 risk factors; and MFI3, 5+ risk factors). Confidence intervals were set at 95% with a P value less than or equal to 0.05 considered statistically significant. Results A total of 17,868 patients (45% male, 55% female) were included and had an average age of 68.5 ± 11.5 years. Odds of any complication, when compared to MFI0, were 1.4 (95% CI [1.3, 1.6]) times greater for MFI1, 3.2 (95% CI [2.8, 3.6]) times greater for MFI2, and 10.8 (95% CI [5.8, 20.0]) times greater for MFI3 (P < 0.001). Odds of readmission, when compared to MFI0, were 1.4 (95% CI [1.3, 1.7]) times greater for MFI1, 2.5 (95% CI [2.1, 3.0]) times greater for MFI2, and 4.1 (95% CI [2.2, 7.8]) times greater for MFI3 (P < 0.001). Conclusion Increasing MFI scores correlate with increased odds of complication and readmission in patients who have undergone revision THA. This MFI may be used to predict the risks after revision THA

Additional file 1: Table S1.ďťżďťżďťż of Granulocyte colony-stimulating factor (G-CSF) promotes spermatogenic regeneration from surviving spermatogonia after high-dose alkylating chemotherapy

This spreadsheet presents the raw results of histological analyses from all experiments. Columns list the numbers and percentages of seminiferous tubules that fall into each category as well as the number of round seminiferous tubules counted and the number of any tubules excluded from analyses. Rows present data for each animal grouped by experimental group and experiment. The summary portion of this table (at bottom) lists averages by experimental group and experiment from the raw data presented above. (XLSX 24 kb