The impact of a virtual orthopaedic surgery symposium on medical students: Increasing awareness and knowledge of the field

UNLABELLED: Orthopaedic surgery has become an increasingly popular field of residency training for medical students. Many institutions offer elective time to explore areas of interest through clinical rotations and research; however, most of these opportunities are reserved for senior medical students. The purpose of this study was to evaluate the impact of a dedicated medical student orthopaedic surgery symposium to increase awareness about the field and to assess students\u27 interest and knowledge of orthopaedic surgery before and after the symposium. METHODS: Medical students were invited to submit orthopaedic surgery-related research to a free, 1-day virtual symposium held in April 2022. Abstracts were reviewed and selected from 9 different orthopaedic surgery subspecialty categories. Survey assessments were sent to medical students to complete before and after the symposium. The surveys included questions related to participant demographics as well as interest and knowledge about the field of orthopaedic surgery. Statistical analyses were completed to compare the participants\u27 responses before and after the symposium. RESULTS: In total, 962 medical students registered for the 4-hour symposium. Of these, 58.5% completed the presymposium survey and 48.0% completed the postsymposium survey. 13.3% of the respondents reported being very knowledgeable about the various orthopaedic surgery subspecialties before the symposium, which increased to 18.4% after the symposium. 46.9% of the participants stated that they were knowledgeable about the daily life of an orthopaedic surgery resident before the symposium, which increased to 67.3% after the symposium. Similarly, the percentage of respondents who reported that they were very knowledgeable about the residency match process increased from 12.2% presymposium to 22.4% postsymposium. CONCLUSIONS: As interest in pursuing a career in orthopaedic surgery increases, medical students will continue to seek information, mentorship, and opportunities to present their research in preparation for residency applications. Our study demonstrated that a large-scale, national, virtual orthopaedic surgery symposium provided a platform to augment medical students\u27 knowledge of the field, present their research, and interact with faculty members. LEVEL OF EVIDENCE: Level V

Impact of Smoking Status on Remission in Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) affects approximately 1-4% of the population. HS is a chronic, recurrent, inflammatory disease of the apocrine sweat glands characterized by recurrent abscessing inflammation. The disease has several known risk factors, one of which is smoking. HS severity is correlated with smoking. However, until now no studies have investigated the impact of smoking on remission rates with therapeutic interventions including surgery and biologic therapy. The purpose of this study is to identify the correlation of smoking status on HS disease activity. This study was conducted through the Wound Etiology and Healing Study (WE-HEAL Study), a biospecimen and data repository approved by The George Washington University IRB (041408). All subjects gave written informed consent for longitudinal collection of their data while they receive treatment according to standard of care. Demographic data, baseline medical comorbidities, smoking exposure and disease activity scores were abstracted from the electronic health record (EHR) and stored using REDCap in the WE-HEAL study database. At datalock, there were 132 patients observed in the HS cohort. Patients were subdivided into groups based upon smoking status: smoker, non-smoker, former smoker (smoking cessation occurred prior to baseline visit), and quit smoking (smoking cessation occurred after baseline visit). Disease activity was assessed using Hurley Stage and Hidradenitis Sartorius Score (HSS). Remission rates were evaluated using the Hidradenitis Suppurativa Clinical Response (HiSCR)

Temporal trends in the rate of complications and prolonged length of stay relative to body mass index in patients undergoing total knee arthroplasty from 2012 to 2020

BACKGROUND: Elevated body mass index (BMI) is a risk factor for complications following total knee arthroplasty (TKA). Thus, we believe it is important to constantly re-evaluate the relationship between BMI and complication risk following TKA. METHOD: Patients undergoing primary TKA were identified in a national database from 2012-2020. Rates of major complications, minor complications, and length of stay (LOS) greater than 2 days were calculated. The prevalence of postoperative outcomes were calculated per unit of BMI and then multiplied by a factor of 10 or 10 in order to create adjusted-BMI (aBMI). To isolate the effect of aBMI on postoperative outcomes, changes over time were analyzed using linear regression analysis controlling for age, sex, American Society of Anesthesiology (ASA) classification and smoking status. RESULTS: 365,333 patients were included. Mean BMI 33 ± 6.8. 10,616 (2.9%) of patients had a major postoperative complication, 9,345 (2.6%) minor complications, 3,277 (0.9%) had a deep or superficial surgical site infection (SSI). 133,563 (37%) of patients had LOS \u3e 2 days. From 2012-2020, the ratio of major complications to aBMI decreased significantly by an average of -2.7% per year. The ratio of patients with LOS \u3e 2 days to aBMI decreased significantly by -27% per year. The ratio of SSI to aBMI increased significantly by 10.8% per year. CONCLUSIONS: From 2012 to 2020, the ratio of major complications and extended LOS following TKA as a function of BMI has decreased significantly, while the ratio of SSI as a function of BMI has doubled

Comparison of Pneumonia and Major Complications After Total Joint Arthroplasty With Spinal Versus General Anesthesia: A Propensity-matched Cohort Analysis

INTRODUCTION: Spinal anesthesia (SA) allows total joint arthroplasty to be done while minimizing opioids and systemic anesthetic agents compared with general anesthesia (GA). SA has been associated with shortened postoperative recovery; however, the relationship between SA, major postoperative complications, and pneumonia (PNA) remains unclear. METHODS: Patients in a large, national database who underwent total hip arthroplasty or total knee arthroplasty from 2010 to 2020 were identified. 1:1 propensity score matching was used to create matched groups of patients who underwent SA and GA. The groups were matched by age, sex, chronic obstructive pulmonary disease, smoking status, Charlson Comorbidity Index, and American Society of Anesthesiology (ASA) classification. 1:1 matching was also done among the ASA classifications as a subanalysis. RESULTS: Overall, equally matched groups of 217,267 patients who underwent SA versus GA were identified. 850 patients (0.39%) developed postoperative PNA after GA versus 544 patients (0.25%) after SA (P \u3c 0.001). The risk of major complications was 6,922 (3.2%) in the GA group and 5,401 (2.5%) in the SA group (P \u3c 0.001). Similarly, the risk of unplanned postoperative reintubation was higher (0.18% versus 0.10%, P \u3c 0.001) and mortality was higher (0.14% versus 0.09%, P \u3c 0.001) in the GA group than in the SA group. In ASA 1 to 3 patients, the risk of PNA was 0.08% to 0.21% higher with GA than with SA. In ASA 4 patients, the risk of PNA was 0.42% higher in SA than in GA (1.92% versus 1.5%, P \u3c 0.001) and the mortality rate was nearly doubled in GA than in SA (1.46% versus 0.77%, P = 0.017). DISCUSSION: Overall, GA was associated with a small but markedly higher rate of major complications, mortality, and PNA than SA in patients undergoing total joint arthroplasty when matching for differences in comorbidities. ASA 4 patients experienced the greatest increase in absolute risk of mortality with GA versus SA