Factors associated with optimal patient outcomes after operative repair of isolated hip fractures in the elderly

Background: Increased time to operative intervention is associated with a greater risk of mortality and complications in adults with a hip fracture. This study sought to determine factors associated with timeliness of operation in elderly patients presenting with an isolated hip fracture and the influence of surgical delay on outcomes. Methods: Trauma quality collaborative data (July 2016 to June 2019) were analyzed. Inclusion criteria were patients ≥65 years with an injury mechanism of fall, Abbreviated Injury Scale (AIS) 2005 diagnosis of hip fracture, and AIS extremity ≤3. Exclusion criteria included AIS in other body regions >1 and non-operative management. We examined the association of demographic, hospital, injury presentation, and comorbidity factors on a surgical delay >48 hours and patient outcomes using multivariable regression analysis. Results: 10 182 patients fit our study criteria out of 212 620 patients. Mean age was 82.7±8.6 years and 68.7% were female. Delay in operation >48 hours occurred in 965 (9.5%) of patients. Factors that significantly increased mortality or discharge to hospice were increased age, male gender, emergency department hypotension, functionally dependent health status (FDHS), advanced directive, liver disease, angina, and congestive heart failure (CHF). Delay >48 hours was associated with increased mortality or discharge to hospice (OR 1.52; 95% CI 1.13 to 2.06; p48 hours were male gender, FDHS, CHF, chronic renal failure, and advanced directive. Admission to the orthopedic surgery service was associated with less incidence of delay >48 hours (OR 0.43; 95% CI 0.29 to 0.64; p<0.001). Discussion: Hospital verification level, admission service, and patient volume did not impact the outcome of mortality/discharge to hospice. Delay to operation >48 hours was associated with increased mortality. The only measured modifiable characteristic that reduced delay to operative intervention was admission to the orthopedic surgery service. Level of evidence: III

Variation in psychological well-being and body image in patients before and after bariatric surgery

Introduction: Massive weight loss with bariatric surgery has the potential to improve body image and psychological well-being. However, traditional instruments used to measure health related quality of life (HRQL) have not been tailored to bariatric patients. Therefore, we sought to utilize a new patient-reported outcome (PRO) instrument to assess psychological well-being and satisfaction with body image before and after bariatric surgery. Methods: We administered the Body-Q survey to two cohorts of patients in the Michigan Bariatric Surgery Collaborative (MBSC)\-pre-bariatric surgery (n=287) and one-year post-bariatric surgery (n=1669). The Body-Q is a patient-reported outcome instrument designed to measure patient perceptions of weight loss. It has been validated in large populations of patients who have undergone bariatric surgery or body contouring procedures to assess PROs in this subset of patients. We linked the survey data to prospectively collected data from the MBSC to assess associations between body image/psychological well-being and clinical characteristics and outcomes such as age, gender, race, income, marital status, BMI, percent excess body weight loss (% EBWL), and comorbidity burden. Results: Higher preoperative body image scores were associated with black race only (p\u3c0.01). Higher preoperative psychological well-being scores were associated with male gender (p\u3c0.001) and black race (p\u3c0.010. There was no association with BMI or other demographic factors in the preoperative setting. Postoperative body image was positively (ie, higher scores) associated with male gender (p\u3c0.001), lower BMI (p\u3c0.0001), and higher mean %EBWL (p\u3c0.0001). Postoperative psychological well-being was positively associated with male gender (p\u3c0.001), black race (p\u3c0.01), lower BMI (p\u3c0.01), and higher mean %EBWL (p\u3c0.0001). When patients were divided into terciles by their body image and psychological well-being scores, the mean %EBWL in the highest scoring terciles were 65.7% and 63.4%, respectively, as compared to 51.9% and 56.2% in the lowest terciles, repectively. Conclusions: There are large variations in psychological and body image outcomes in patients both before and after bariatric surgery. Recognition of these differences and factors contributing to lower reported levels of psychological well-being and body image may help providers provide appropriate counseling in the perioperative period

The current utilization of the patient-reported outcome measurement information system (PROMIS) in isolated or combined total knee arthroplasty populations

Abstract Patient reported outcome measures (PROMs) are essential for clinical research and patient-centric care because they allow us to capture patient perspectives on their health condition. In knee arthroplasty, PROMs are frequently used to assess the risks and benefits of new interventions, surgical approaches, and other management strategies. A few examples of PROMs used in total knee arthroplasty (TKA) include the Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Forgotten Joint Score (FJS) (collectively referred to as “legacy” PROMs). More recently, attention has been brought to another PROM called the Patient-Reported Outcomes Measurement Information System (PROMIS). PROMIS was developed by the National Institute of Health (NIH) and has over 300 domains assessing various aspects of patient health, including pain, physical function, and mental health. With the use of PROMIS increasing in TKA literature, there is a need to review the advancements being made in understanding and applying PROMIS for this population. Thus, the purpose of this study is to provide insight on the utilization, advantages, and disadvantages of PROMIS within the field of knee arthroplasty and to provide a comparison to legacy PROMs

A Longitudinal Analysis of Variation in Psychological Well-being and Body Image in Patients Before and After Bariatric Surgery

MINI: In this multicenter, prospective cohort study we conducted a longitudinal assessment of a bariatric-specific, patient-reported outcome instrument. We assessed psychological well-being and satisfaction with body image before and after bariatric surgery, and its association with clinical outcomes. OBJECTIVE: We sought to use a bariatric-tailored patient-reported outcome (PRO) instrument to assess psychological well-being and satisfaction with body image before and after bariatric surgery, and its association with clinical outcomes. BACKGROUND: Weight loss after bariatric surgery has the potential to improve body image and psychological well-being. Traditional instruments used to measure these PROs have, however, not been tailored to patients who have undergone bariatric surgery. METHODS: In this multicenter, prospective, longitudinal cohort study we administered the Body-Q survey (a validated, customized PRO instrument) to patients in the Michigan Bariatric Surgery Collaborative just before bariatric surgery and at 1-year postoperatively. We linked the survey data to prospectively collected clinical outcome data to assess associations between body image or psychological well-being and patient characteristics and clinical outcomes (ie, percent excess body weight loss and complications). RESULTS: The preoperative and postoperative surveys were completed by 4068 patients for body image and 4062 patients for psychological well-being. Overall mean scores for body image and psychological well-being improved significantly from 26.2 ± 21.4 and 70.8 ± 20.1, respectively, before surgery to 57.7 ± 21.1 and 78.1 ± 22.1 after surgery. For both body image and psychological well-being, we found several patient-level factors such as sex, race, income level, and baseline body mass index that were statistically significant predictors of increases in scores. All P values less than 0.05. CONCLUSIONS: Psychological well-being and body image vary widely across patients before bariatric surgery with significant increases in both measures 1 year postoperatively. Some patient populations do not experience the same increases at 1 year. Recognition of these differences and factors contributing to lower reported levels of psychological well-being and body image may help providers provide appropriate counseling in the postoperative period

A comparison of pin site complications between large and small pin diameters in robotic‐assisted total knee arthroplasty

Abstract Purpose Robotic‐assisted total knee arthroplasty typically necessitates use of tracking pins, which can vary in diameter. Complications such as infections and fractures at the pin‐site have been observed, but clarification of the effect of pin diameter on complication is needed. The aim of this study is to compare the pin‐related complication rates following robotic‐assisted total knee arthroplasty between 4.5 mm and 3.2 mm diameter pins. Methods In this retrospective cohort study, 90‐day pin‐site complication rates after robotic‐assisted total knee arthroplasty were compared between 4.5 mm diameter and 3.2 mm diameter groups. In total, 367 patients were included: 177 with large pin diameter and 190 with small pin diameter. All four pin sites were evaluated using postoperative radiographs. Cases without orthogonal views or visualization of all four pin tracts were noted. Multivariate logistic regression was used to control for age, which differed between the two cohorts. Results The rate of pin‐site complications was 5.6% in the large pin diameter cohort and 2.6% in the small pin diameter cohort, with no statistically significant difference between the groups. The adjusted odds ratio for complications in small compared to large diameter group was 0.48, with a p‐value of 0.18. The most common pin‐site complication was infection/persistent drainage, found in 1.9% of patients, followed by intraoperative fracture of the second cortex in 1.4%. Intraoperative fracture could not be ruled out in 96 cases due to inadequate radiographic visualization of all pin sites. There was one postoperative pin‐site fracture in the large diameter cohort, which required operative fixation. Conclusion This study demonstrates no statistically significant difference in pin‐site complication rates after robotic‐assisted total knee arthroplasty between 4.5 mm and 3.2 mm pin diameter cohorts, although there was a trend towards increased intraoperative and postoperative pin‐site fractures in the 4.5 mm group