Preop Opioid Use Associated with Higher Readmission and Revision Rates after TJA
Prescription opioid use is epidemic in the U.S. Recently, an association was demonstrated between preoperative opioid use and increased health-care utilization following abdominal surgeries. #JBJSInfographics #visualabstract #JBJS
Full article: https://bit.ly/2uVhwfl
Tags: Hip, Infographic, Knee, Video Summary, Visual Abstract
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My TweetsOrthopedic trauma patients endure significant worry and financial distress comparable to other serious medical conditions such as cancer.
Bhashyam et al. report the findings of a survey of 236 orthopedic trauma patients in the July 17th issue of The Journal. Using two validated measures (financial burden composite and dichotomized worry score), they assessed the emotional and financial hardships associated with experiencing a musculoskeletal trauma. Of 393 consecutive eligible patients, 236 consented to and completed the surveys which were performed an average of 2 years after injury.
In this injury cohort, the financial burden composite score was 2.4 (0 = low burden and 6 = highest burden) and 24.9% of patients had high levels of worry about financial problems resulting from their trauma. Among these patients, 54% used money from their savings to pay for care and 23% borrowed money.
Factors associated with high financial burden included: younger age at injury, nonwhite race, marital status, decreased education level, decreased median income, polytrauma, increased number of operations, prior loans, and insurance type. Factors associated with decreased financial hardship were married marital status and completion of graduate school.
Recognizing this aspect of burden and emotional toll in the orthopedic trauma patient is important when caring for this population. Previously studies have shown such ancillary stresses can impede recovery and depreciate clinical outcomes. Screening for risk factors in the early care period may help identify patients at risks and who may benefit from additional counseling.
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Time for the JBJS Clinical Classroom Challenge of the Week!
Do you know the answer? https://bit.ly/2Y28dps
Chad Krueger, MD discusses the article "generational Differences in Grit, Self-Control, and Conscientiousness Among Orthopaedic Surgeons" in the July 17th issue of The Journal.
This article can be found at jbjs.org
#jbjs #orthopedics #orthopedicsurgery #ortho #orthosurgery #surgery #medicine #grit #education #evidencebasedmedicine #orthopedicresidency #orthoresidency #medicalschool
How are cementless TKAs doing?
In the July 3rd issue of The Journal, Nam et al. report on their RCT comparing cemented versus uncemented TKAs at a single institution. Selected patients were randomized to receive a cemented cruciate-retaining TKA or a cementless, highly porous cruciate-retaining TKA of the same design. Patients were followed for an average of 2 years post op and Oxford Knee, Knee Society, and Forgotten Joint Scores were collected.
A total of 141 patients were ultimately included in the final review. There were no differences in any clinical outcome measures at 6 weeks, 1 year, or an average of 2 years post op (p = 0.1 to 0.9). Operative times were different between the two groups with the cementless TKA having slightly decreased OR times (82.1 min vs 93.7; p = 0.001). The cementless group showed no evidence of implant loosening or osteolysis 2 year follow up.
This study seems to support the use of cementless TKAs. Patient reported outcomes and radiographic outcomes appear to be similar between the two TKA designs. While the study is well designed, it only evaluates short term (2 years) outcomes and more studies will be needed to assess the durability and longevity of these early satisfactory outcomes seen at 2 years post op.
#jbjs #orthopedics #orthopedicsurgery #ortho #orthosurgery #surgery #medicine #arthroplasty #totaljointreplacement #kneereplacement #kneearthroplasty #totalkneearthroplasty #evidencebasedmedicine #orthopedicresidency #orthoresidency #medicalschool
Assessing racial/ethnic disparities in THA outcomes among patients enrolled in an integrated health-care system.
In the July 3rd issue of The Journal, Okike et al. evaluated the Kaiser Permanente Total Joint Replacement Registry to identify all patients who underwent a THA and collected demographic, surgical, and outcome data. Racial/ethnic differences in outcome were then analysed using multiple regression.
The authors found that minority patients had similar or lower rates of lifetime revision and 90-day post operative events compared to white patients. A higher rate of 90-day emergency department visits were seen among black (OR 1.15) and Hispanic (OR 1.18) patients.
This article concludes that, contrary to previous literature, minority patients enrolled in a managed health-care system had similar or lower rates of reoperation and 90-day complications compared to white patients.
This article can be found on jbjs.org in the July 3rd issue of The Journal.
#jbjs #orthopedics #orthopedicsurgery #ortho #orthosurgery #surgery #medicine #arthroplasty #totaljointreplacement #hipreplacement #hiparthroplasty #totalhiparthroplasty #evidencebasedmedicine #orthopedicresidency #orthoresidency #medicalschool
Need an update on Orthopedic Trauma!? In the July 3rd issue of The Journal, Dehgahn and McKee review the most recent, high-impact articles on Orthopedic Trauma.
Topics include: AC joint injuries, proximal humerus fractures, elbow trauma, distal radius fractures, pelvic fractures, hip trauma, ankle injuries, pediatric fractures, and geriatric trauma.
And as always, this excellent review is open access and can be found on jbjs.org
Enjoy!
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