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  • 1
    Online Resource
    Online Resource
    Effects of Ramelteon on the Prevention of Postoperative Delirium in Older Patients Undergoing Orthopedic Surgery: The RECOVER Randomized Controlled Trial
    Elsevier BV ; 2021
    In:  The American Journal of Geriatric Psychiatry Vol. 29, No. 1 ( 2021-01), p. 90-100
    Details
    In: The American Journal of Geriatric Psychiatry, Elsevier BV, Vol. 29, No. 1 ( 2021-01), p. 90-100
    Type of Medium: Online Resource
    ISSN: 1064-7481
    URL: Article
    DOI: 10.1016/j.jagp.2020.05.006
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 1474415-6
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  • 2
    Online Resource
    Online Resource
    Predictors and Outcomes of Postoperative Hemoglobin of 〈8 g/dL in Total Joint Arthroplasty
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Journal of Bone and Joint Surgery Vol. 104, No. 2 ( 2022-1-19), p. 166-171
    Details
    In: Journal of Bone and Joint Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 104, No. 2 ( 2022-1-19), p. 166-171
    Abstract: Restrictive transfusion practices have decreased transfusions in total joint arthroplasty (TJA). A hemoglobin threshold of 〈 8 g/dL is commonly used. Predictors of this degree of postoperative anemia in TJA and its association with postoperative outcomes, independent of transfusions, remain unclear. We identified predictors of postoperative hemoglobin of 〈 8 g/dL and outcomes with and without transfusion in TJA. Methods: Primary elective TJA cases performed with a multimodal blood management protocol from 2017 to 2018 were reviewed, identifying 1,583 cases. Preoperative and postoperative variables were compared between patients with postoperative hemoglobin of 〈 8 and ≥8 g/dL. Logistic regression and receiver operating characteristic curves were used to assess predictors of postoperative hemoglobin of 〈 8 g/dL. Results: Positive predictors of postoperative hemoglobin of 〈 8 g/dL were preoperative hemoglobin level (odds ratio [OR] per 1.0-g/dL decrease, 3.0 [95% confidence interval (CI), 2.4 to 3.7] ), total hip arthroplasty (OR compared with total knee arthroplasty, 2.1 [95% CI, 1.3 to 3.4]), and operative time (OR per 30-minute increase, 2.0 [95% CI, 1.6 to 2.6] ). Negative predictors of postoperative hemoglobin of 〈 8 g/dL were tranexamic acid use (OR, 0.42 [95% CI, 0.20 to 0.85]) and body mass index (OR per 1 kg/m 2 above normal, 0.90 [95% CI, 0.86 to 0.94]). Preoperative hemoglobin levels of 〈 12.4 g/dL in women and 〈 13.4 g/dL in men best predicted postoperative hemoglobin of 〈 8 g/dL. Overall, 5.2% of patients with postoperative hemoglobin of 7 to 8 g/dL and 95% of patients with postoperative hemoglobin of 〈 7 g/dL received transfusions. Patients with postoperative hemoglobin of 〈 8 g/dL had longer hospital stays (p 〈 0.001) and greater rates of emergency department visits or readmissions (p = 0.001) and acute kidney injury (p 〈 0.001). Among patients with postoperative hemoglobin of 〈 8 g/dL, patients who received transfusions had a lower postoperative hemoglobin nadir (p 〈 0.001) and a longer hospital stay (p = 0.035) than patients who did not receive transfusions. Conclusions: Postoperative hemoglobin of 〈 8 g/dL after TJA was associated with worse outcomes, even for patients who do not receive transfusions. Optimizing preoperative hemoglobin levels may mitigate postoperative anemia and adverse outcomes. Level of Evidence: Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.
    Type of Medium: Online Resource
    ISSN: 0021-9355 , 1535-1386
    URL: Article
    DOI: 10.2106/JBJS.20.01766
    RVK:
    XA 52200.A
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 3
    Online Resource
    Online Resource
    Factors Associated With Perioperative Transfusion in Lower Extremity Revision Arthroplasty Under a Restrictive Blood Management Protocol
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Journal of the American Academy of Orthopaedic Surgeons Vol. 29, No. 8 ( 2021-04-15), p. e404-e409
    Details
    In: Journal of the American Academy of Orthopaedic Surgeons, Ovid Technologies (Wolters Kluwer Health), Vol. 29, No. 8 ( 2021-04-15), p. e404-e409
    Abstract: Approximately 37% of patients undergoing lower extremity revision total joint arthroplasty (TJA) receive allogeneic blood transfusions (ABTs), which are associated with increased risk of morbidity and death. It is important to identify patient factors associated with needing ABT because the health of higher-risk patients can be optimized preoperatively and their need for ABT can be minimized. Our goal was to identify the patient and surgical factors independently associated with perioperative ABT in revision TJA. Methods: We included all 251 lower extremity revision TJA cases performed at our academic tertiary care center from January 1, 2016, to December 31, 2018. We assessed the following factors for associations with perioperative ABT: patient age, sex, race, body mass index, preoperative hemoglobin level, and infection status (ie, infection as indication for revision TJA); use of vasopressors, tranexamic acid (TXA), surgical drains, tourniquets, and intraoperative cell salvage; and procedure type (hip versus knee), procedure complexity (according to the number of components revised), and surgical time. Multivariable regression was used to identify factors independently associated with perioperative ABT. Results: The following characteristics were independently associated with greater odds of perioperative ABT: preoperative hemoglobin level (odds ratio [OR], 1.8; 95% confidence interval [CI] , 1.5 to 2.2), infectious indication for revision (OR, 3.6; 95% CI, 1.3 to 9.7), and procedure complexity. TXA use was a negative predictor of ABT (OR, 0.47; 95% CI, 0.23 to 0.98). Compared with polyethylene liner exchanges, single-component revisions (OR, 14; 95% CI, 3.6 to 56) and dual-component revisions (OR, 7.8; 95% CI, 2.3 to 26) were associated with greater odds of ABT. Discussion: Patients with preoperative anemia, those undergoing revision TJA because of infection, those who did not receive TXA, and those undergoing more complex TJA procedures may have greater odds of requiring ABT. We recommend preoperative optimization of the health of these patients to reduce the need for ABT. Level of Evidence: Level III, prognostic study
    Type of Medium: Online Resource
    ISSN: 1067-151X , 1940-5480
    URL: Article
    DOI: 10.5435/JAAOS-D-20-00185
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 4
    Online Resource
    Online Resource
    Complications and 30-Day Mortality Rate After Hip Fracture Surgery in Superobese Patients
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Journal of Orthopaedic Trauma Vol. 35, No. 6 ( 2021-06), p. 322-328
    Details
    In: Journal of Orthopaedic Trauma, Ovid Technologies (Wolters Kluwer Health), Vol. 35, No. 6 ( 2021-06), p. 322-328
    Abstract: Paradoxically, overweight and obesity are associated with lower odds of complications and death after hip fracture surgery. Our objective was to determine whether this “obesity paradox” extends to patients with “superobesity.” In this study, we compared rates of complications and death among superobese patients with those of patients in other body mass index (BMI) categories. Methods: Using the National Surgical Quality Improvement Program database, we identified 〉 100,000 hip fracture surgeries performed from 2012 to 2018. Patients were categorized as underweight (BMI 〈 18.5), normal weight (BMI 18.5–24.9), overweight (BMI 25–29.9), obese (BMI 30–39.9), morbidly obese (BMI 40–49.9), or superobese (BMI ≥50). We analyzed patient characteristics, surgical characteristics, and 30-day outcomes. Using multivariate regression with normal-weight patients as the referent, we determined odds of major complications, minor complications, and death within 30 days by BMI category. Results: Of 440 superobese patients, 20% had major complications, 33% had minor complications, and 5.2% died within 30 days after surgery. When comparing patients in other BMI categories with normal-weight patients, superobese patients had the highest odds of major complications [odds ratio (OR): 1.6, 95% confidence interval (CI), 1.2–2.0] but did not have significantly different odds of death (OR: 0.91, 95% CI, 0.59–1.4) or minor complications (OR: 1.2, 95% CI, 0.94–1.4). Conclusion: Superobese patients had significantly higher odds of major complications within 30 days after hip fracture surgery compared with all other patients. This “obesity paradox” did not apply to superobese patients. Level of Evidence: Prognostic Level III. See Instructions for Authors for a Complete Description of Levels of Evidence.
    Type of Medium: Online Resource
    ISSN: 0890-5339
    URL: Article
    DOI: 10.1097/BOT.0000000000001987
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2041334-8
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  • 5
    Online Resource
    Online Resource
    Do Prior Intra-Articular Corticosteroid Injections or Time of Administration Increase the Risks of Subsequent Periprosthetic Joint Infections after Total Knee Arthroplasty?
    Begell House ; 2016
    In:  Journal of Long-Term Effects of Medical Implants Vol. 26, No. 3 ( 2016), p. 191-197
    Details
    In: Journal of Long-Term Effects of Medical Implants, Begell House, Vol. 26, No. 3 ( 2016), p. 191-197
    Type of Medium: Online Resource
    ISSN: 1050-6934
    URL: Issue
    URL: Article
    DOI: 10.1615/JLongTermEffMedImplants.v26.i3
    DOI: 10.1615/JLongTermEffMedImplants.2016014045
    Language: English
    Publisher: Begell House
    Publication Date: 2016
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  • 6
    Online Resource
    Online Resource
    Inpatient Mortality and Morbidity for Dialysis-Dependent Patients Undergoing Primary Total Hip or Knee Arthroplasty
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Journal of Bone and Joint Surgery Vol. 97, No. 16 ( 2015-8-19), p. 1326-1332
    Details
    In: Journal of Bone and Joint Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 97, No. 16 ( 2015-8-19), p. 1326-1332
    Type of Medium: Online Resource
    ISSN: 0021-9355 , 1535-1386
    URL: Article
    DOI: 10.2106/JBJS.N.01301
    RVK:
    XA 52200.A
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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  • 7
    Online Resource
    Online Resource
    Cementless Femoral Fixation in Total Hip Arthroplasty
    Ovid Technologies (Wolters Kluwer Health) ; 2011
    In:  Journal of Bone and Joint Surgery Vol. 93, No. 5 ( 2011-3-2), p. 500-509
    Details
    In: Journal of Bone and Joint Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 93, No. 5 ( 2011-3-2), p. 500-509
    Type of Medium: Online Resource
    ISSN: 0021-9355 , 1535-1386
    URL: Article
    DOI: 10.2106/JBJS.J.00774
    RVK:
    XA 52200.A
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2011
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  • 8
    Online Resource
    Online Resource
    Lupus and Perioperative Complications in Elective Primary Total Hip or Knee Arthroplasty
    XMLink ; 2020
    In:  Clinics in Orthopedic Surgery Vol. 12, No. 1 ( 2020), p. 37-
    Details
    In: Clinics in Orthopedic Surgery, XMLink, Vol. 12, No. 1 ( 2020), p. 37-
    Type of Medium: Online Resource
    ISSN: 2005-291X , 2005-4408
    URL: Article
    DOI: 10.4055/cios.2020.12.1.37
    Language: English
    Publisher: XMLink
    Publication Date: 2020
    detail.hit.zdb_id: 2485469-4
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  • 9
    Online Resource
    Online Resource
    A Restrictive Hemoglobin Transfusion Threshold of Less Than 7 g/dL Decreases Blood Utilization Without Compromising Outcomes in Patients With Hip Fractures
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Journal of the American Academy of Orthopaedic Surgeons Vol. 27, No. 23 ( 2019-12-1), p. 887-894
    Details
    In: Journal of the American Academy of Orthopaedic Surgeons, Ovid Technologies (Wolters Kluwer Health), Vol. 27, No. 23 ( 2019-12-1), p. 887-894
    Abstract: In patients with hip fracture, a transfusion threshold of hemoglobin (Hb) 〈 8 g/dL is associated with similar or better outcomes than more liberal thresholds. Whether a more restrictive threshold of 〈 7 g/dL Hb produces equivalent outcomes in such patients is unknown. The aim of the study was to examine whether a restrictive threshold of 〈 7 g/dL Hb is safe in this population. Methods: In January 2015, a blood management program was implemented that uses a restrictive transfusion threshold of 〈 7 g/dL Hb in hemodynamically stable patients and 〈 8 g/dL in patients with symptomatic anemia or a history of coronary artery disease. We identified 498 patients treated for hip fractures from January 2013 through May 2017. We compared perioperative outcomes of 207 patients treated before with those of 291 patients treated after restrictive threshold implementation. Results: After restrictive threshold implementation, the proportion of patients receiving packed red blood cell (PRBC) transfusions decreased from 51% to 33% ( P 〈 0.001); the mean number of PRBC units transfused per patient decreased by 40% (from 1.1 to 0.7; P 〈 0.001); inpatient cardiac morbidity decreased from 22.2% to 12.4% ( P = 0.004); 30-day readmissions decreased from 14% to 8.6% ( P = 0.04); and length of stay was unchanged ( P = 0.06). Compared with the prerestrictive threshold cohort, the postrestrictive threshold group had lower odds of transfusion (odds ratio [OR] = 0.42; 95% confidence interval [CI] , 0.29 to 0.62); transfusion of 〉 1 unit of PRBCs (OR = 0.34; 95% CI, 0.22 to 0.52); and inpatient cardiac morbidity (OR = 0.45; 95% CI, 0.27 to 0.75). No significant differences were observed in inpatient morbidity, mortality, 30-day readmission, or 90-day survival. Discussion: A restrictive threshold of 〈 7 g/dL Hb in hemodynamically stable patients with hip fractures is associated with noninferior perioperative outcomes and less blood utilization compared with a threshold of 〈 8 g/dL. Level of Evidence: Level III, retrospective cohort study
    Type of Medium: Online Resource
    ISSN: 1067-151X , 1940-5480
    URL: Article
    DOI: 10.5435/JAAOS-D-18-00374
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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  • 10
    Online Resource
    Online Resource
    Intraoperative and Postoperative Iron Supplementation in Elective Total Joint Arthroplasty: A Systematic Review
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Journal of the American Academy of Orthopaedic Surgeons Vol. 29, No. 23 ( 2021-12-1), p. e1200-e1207
    Details
    In: Journal of the American Academy of Orthopaedic Surgeons, Ovid Technologies (Wolters Kluwer Health), Vol. 29, No. 23 ( 2021-12-1), p. e1200-e1207
    Abstract: Postoperative anemia is associated with substantial morbidity and mortality in total joint arthroplasty (TJA). Our primary objective was to determine whether perioperative iron supplementation improves postoperative hemoglobin levels in TJA. Secondary objectives were to determine the effects of perioperative iron on adverse events, quality of life, and functional measures in TJA. Methods: We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using six databases. We included English-language, randomized controlled trials investigating intraoperative or postoperative iron supplementation in elective TJA that reported postoperative hemoglobin levels in patients aged 18 years or older. Seven eligible studies were identified, among which substantial heterogeneity was noted. Bias risk was low in four studies, unclear in two studies, and high in one study. Three studies assessed oral iron supplementation, three assessed intravenous iron supplementation, and one compared oral and intravenous iron supplementation. All intravenous iron was administered intraoperatively, except in the oral versus intravenous comparison. Results: Postoperative oral iron supplementation had no effect on postoperative hemoglobin levels. Intraoperative and postoperative intravenous iron supplementation was associated with higher postoperative hemoglobin levels and greater increases in hemoglobin levels. Two studies reported rates of anemia and found that intraoperative and postoperative intravenous iron supplementation reduced rates of postoperative anemia at postoperative day 30. No adverse events were associated with iron supplementation. One study found that intravenous iron improved quality of life in TJA patients with severe postoperative anemia compared with those treated with oral iron. Perioperative iron had no effects on functional outcomes. Discussion: We found no evidence that postoperative oral iron supplementation improves hemoglobin levels, quality of life, or functional outcomes in elective TJA patients. However, intraoperative and postoperative intravenous iron supplementation may accelerate recovery of hemoglobin levels in these patients. Level of Evidence: Level I, systematic review of randomized controlled trials
    Type of Medium: Online Resource
    ISSN: 1067-151X , 1940-5480
    URL: Article
    DOI: 10.5435/JAAOS-D-20-01171
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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