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Plancher KD, Schwartz EN, Mannina CM, Briggs KK, Petterson SC. High Altitude is an Independent Risk Factor for Postoperative Venous Thromboembolism Following Primary Total Knee Arthroplasty: A Large Database Study. J Arthroplasty 2024:S0883-5403(24)01325-1. [PMID: 39716508 DOI: 10.1016/j.arth.2024.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 06/12/2024] [Revised: 12/17/2024] [Accepted: 12/17/2024] [Indexed: 12/25/2024] Open
Abstract
BACKGROUND High altitude may induce physiological changes that can predispose patients to venous thromboembolism (VTE), a relatively uncommon, but potentially fatal complication following total knee arthroplasty (TKA). The purpose of this study was to determine if high altitude is an independent risk factor for postoperative VTE following TKA. METHODS A large claims database was queried for patients who underwent TKA at high-altitude (≥ 1,219-meters) and low-altitude (≤ 30-meters) using Current Procedural Terminology codes, International Classification of Disease codes, and zip codes. High- and low-altitude cohorts were matched 1:3 by 5-year age range, sex, Charlson comorbidity index (CCI), diabetes mellitus, obesity (body mass index ≥ 30), hypertension, and tobacco use. There were 57,135 patients included in the high-altitude group and 171,322 in the low-altitude group. Outcome measures included 30- and 90-day incidence of VTE, deep venous thrombosis (DVT), and pulmonary embolism (PE). Chi-square was used to determine differences in demographics. Binomial logistic regression was used to determine postoperative rates of VTE, DVT, and PE. RESULTS The incidence of VTE was significantly greater in the high-altitude versus the low-altitude group at 30-days (OR [odds ratio] 1.15 [95% CI (confidence interval) 1.02 to 1.30], P = 0.022) and 90-days (OR 1.20 [95% CI 1.08 to 1.34], P = 0.0007). The incidence of DVT was significantly higher for the high-altitude cohort at both 30- (OR 1.30 [95% CI 1.10 to 1.54], P = 0.002) and 90-days (OR 1.36 [95% CI 1.18 to 1.57], P < 0.0001). The incidence of PE within 30- and 90-days was not significantly different between groups. CONCLUSIONS High altitude (> 1,219-meters) is an independent risk factor for VTE following TKA. Patients who undergo TKA at surgical centers greater than 1,219-meters in elevation are more likely to develop VTE and DVT within 30- and 90-days postoperatively. Surgeons may account for high altitude as a risk factor and determine the most suitable postoperative prophylaxis method for their patients.
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Affiliation(s)
- Kevin D Plancher
- Department of Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New York; Plancher Orthopaedics & Sports Medicine, New York, New York; Orthopaedic Foundation, Stamford, Connecticut
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Yadav C, Kabra A, Hussain A, Morup T, Dorje T, Mittal S. Arthroplasty at Very High Altitude with Restricted Resources: Our Experience and Review of Literature. Indian J Orthop 2024; 58:1418-1422. [PMID: 39324095 PMCID: PMC11420413 DOI: 10.1007/s43465-024-01191-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 03/09/2023] [Accepted: 05/22/2024] [Indexed: 09/27/2024]
Abstract
Introduction Patients living in high altitudes are often deprived of total knee arthroplasty (TKA) due to logistic reasons, economic, and social challenges in performing surgical procedures for management of knee pain. Surgical procedures in high-altitude dwellers have associated risk of deep venous thrombosis/pulmonary embolism (DVT/PE). In patients undergoing these procedures at lower altitudes, return to high altitudes can cause high-altitude pulmonary edema (HAPE). We share our experience of performing TKA in high-altitude dwellers by setting up a surgical camp at 11,000 feet. Methods A retrospective assessment of patients undergoing total knee arthroplasty at a camp set up at 11,000 feet between 2014 and 2020 was undertaken. Follow-up data of patients which included clinical assessment by the Knee Society Score (KSS) and complications like DVT, infection, residual deformity, etc. were included in the study. Radiographic evaluation to look for evidence of implant loosening was also inculcated. Results 132 patients (202 knee joints in 50 male and 82 female patients) underwent TKA during annual camps. The average follow-up of patients was 60 months. Mean pre-operative KSS was 38, which was increased to 83 at 1-year follow-up post-surgery. There was no evidence of DVT or superficial or deep infection in any patient in the post-operative period. Conclusion With this study, we want to highlight that total knee arthroplasty can be safely performed at high altitudes and remote areas with limited health facilities. We believe it is a safer and more convenient prospect for the residents of high-altitude regions. Level of evidence III.
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Affiliation(s)
| | - Apoorva Kabra
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Anwar Hussain
- Consultant Orthopaedic Surgeon, SNM Hospital, Leh, Ladakh India
| | - Tsering Morup
- Consultant Anaesthetist, SNM Hospital, Leh, Ladakh India
| | - Tsewang Dorje
- Consultant Orthopaedic Surgeon, SNM Hospital, Leh, Ladakh India
| | - Samarth Mittal
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, 110029 India
- Jai Prakash Narayan Apex Trauma Centre, New Delhi, India
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3
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Li K, Luobu G, Wu P, Ciren D, Xiao X, Li K, Li Q. Ameliorating effects of the HIF-2α inhibitor PT2385 on high-altitude polycythemia. Eur J Pharm Sci 2024; 201:106857. [PMID: 39032535 DOI: 10.1016/j.ejps.2024.106857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 02/20/2024] [Revised: 07/04/2024] [Accepted: 07/17/2024] [Indexed: 07/23/2024]
Abstract
High-altitude polycythemia (HAPC) is a common chronic altitude disease caused by living in low-pressure and low-oxygen environment. At present, there is still no effective cure for HAPC. HIF-2α may play an important role in the development of HAPC in regulating the increased red blood cell excessively induced by HIF-EPO and the blood vessel formation induced by VEGF-VEGFR. Here, we established a rat HAPC model and treated it with the HIF-2α inhibitor PT2385. We mainly evaluated the therapeutic effect of PT2385 on HAPC rats by observing the changes in rat phenotype, tissue and organ damage, red blood cell and hemoglobin content, angiogenesis, lipid peroxidation reaction, and inflammatory factors. The results showed that PT2385 treatment improved the congestion phenotype characteristics, inhibited increased erythrocytes and hemoglobin, reduced blood vessel formation, lipid peroxidation, and inflammation, and reduced tissue and organ damage in HAPC rats. This study preliminarly explains the physiological, pathological, and immunological effects of PT2385 treatment for HAPC. It provides a new idea, a reliable experimental basis, and theoretical support for the clinical prevention and treatment of HAPC.
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Affiliation(s)
- Kang Li
- Tibet Plateau Medical Research Institute, People's Hospital of Tibet Autonomous Region, Lhasa 850000, China
| | - Gesang Luobu
- Tibet Plateau Medical Research Institute, People's Hospital of Tibet Autonomous Region, Lhasa 850000, China
| | - Ping Wu
- Department of Occupational Diseases, The Second Affiliated Hospital of Chengdu Medical College Nuclear Industry 416 Hospital, Chengdu, Sichuan 610051, China
| | - Dawa Ciren
- Tibet Plateau Medical Research Institute, People's Hospital of Tibet Autonomous Region, Lhasa 850000, China
| | - Xue Xiao
- Medicine and Engineering Interdisciplinary Research Laboratory of Nursing & Materials/Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Ka Li
- Medicine and Engineering Interdisciplinary Research Laboratory of Nursing & Materials/Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China.
| | - Qijie Li
- Medicine and Engineering Interdisciplinary Research Laboratory of Nursing & Materials/Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China.
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4
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Zhao ML, Lu ZJ, Yang L, Ding S, Gao F, Liu YZ, Yang XL, Li X, He SY. The cardiovascular system at high altitude: A bibliometric and visualization analysis. World J Cardiol 2024; 16:199-214. [PMID: 38690218 PMCID: PMC11056872 DOI: 10.4330/wjc.v16.i4.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 11/22/2023] [Revised: 02/14/2024] [Accepted: 04/01/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND When exposed to high-altitude environments, the cardiovascular system undergoes various changes, the performance and mechanisms of which remain controversial. AIM To summarize the latest research advancements and hot research points in the cardiovascular system at high altitude by conducting a bibliometric and visualization analysis. METHODS The literature was systematically retrieved and filtered using the Web of Science Core Collection of Science Citation Index Expanded. A visualization analysis of the identified publications was conducted employing CiteSpace and VOSviewer. RESULTS A total of 1674 publications were included in the study, with an observed annual increase in the number of publications spanning from 1990 to 2022. The United States of America emerged as the predominant contributor, while Universidad Peruana Cayetano Heredia stood out as the institution with the highest publication output. Notably, Jean-Paul Richalet demonstrated the highest productivity among researchers focusing on the cardiovascular system at high altitude. Furthermore, Peter Bärtsch emerged as the author with the highest number of cited articles. Keyword analysis identified hypoxia, exercise, acclimatization, acute and chronic mountain sickness, pulmonary hypertension, metabolism, and echocardiography as the primary research hot research points and emerging directions in the study of the cardiovascular system at high altitude. CONCLUSION Over the past 32 years, research on the cardiovascular system in high-altitude regions has been steadily increasing. Future research in this field may focus on areas such as hypoxia adaptation, metabolism, and cardiopulmonary exercise. Strengthening interdisciplinary and multi-team collaborations will facilitate further exploration of the pathophysiological mechanisms underlying cardiovascular changes in high-altitude environments and provide a theoretical basis for standardized disease diagnosis and treatment.
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Affiliation(s)
- Mao-Lin Zhao
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Zhong-Jie Lu
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Li Yang
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Sheng Ding
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Feng Gao
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Yuan-Zhang Liu
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Xue-Lin Yang
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Xia Li
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Si-Yi He
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China.
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Yazdi H, Eslami A, Torkaman A, Elahifar O, Kasaeian A, Alimoghadam S, Alimoghadam R, Abolghasemian M. Aspirin is as effective as low molecular weight heparins in preventing symptomatic venous thromboembolism following arthroscopic anterior cruciate ligament reconstruction. BMC Musculoskelet Disord 2024; 25:154. [PMID: 38373950 PMCID: PMC10875785 DOI: 10.1186/s12891-024-07282-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 08/23/2023] [Accepted: 02/14/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE The optimal agent for thromboprophylaxis following arthroscopic anterior cruciate ligament reconstruction (ACLR) remains unclear, particularly in patients with a low baseline risk for venous thromboembolism (VTE). This retrospective cohort study aims to compare the effectiveness and safety of aspirin versus low molecular weight heparins (LMWHs) in this specific patient population. METHODS We analyzed data from patients who underwent ACLR between March 2016 and March 2021, focusing on those with a low risk for VTE. High-risk individuals, identified by factors such as cardiac disease, pulmonary disease, diabetes mellitus, previous VTE, inflammatory bowel disease, active cancer, and a BMI > 40, were excluded (n = 33). Our approach included a thorough review of medical charts, surgical reports, and pre-operative assessments, complemented by telephone follow-up conducted over a 3-month period by a single investigator. We assessed the incidence of symptomatic VTE, including deep vein thrombosis and pulmonary thromboembolism, as the primary outcome. The secondary outcomes included to complications related to the surgery and thromboprophylaxis. Statistical analysis included descriptive statistics, univariate logistic regression models, and calculations of incidence rates. RESULT In our study, 761 patients (761 knees) were included, with 458 (60.18%) receiving aspirin and 303 (39.82%) receiving LMWH. The two groups showed no significant differences in demographic factors except for age. The incidence of VTE was reported at 1.31% (10 individuals). Specifically, five patients in the aspirin group (1.09%) and five patients in the LMWH group (1.65%) developed a symptomatic VTE event (p = 0.53). Additionally, the two groups did not significantly differ in terms of other complications, such as hemarthrosis or surgical site infection (p > 0.05). Logistic regression analysis revealed no statistically significant difference in VTE risk between the two groups. CONCLUSION This study, focusing on isolated ACLR in patients with a low baseline risk for venous thromboembolism, demonstrated that aspirin is equally effective as low molecular weight heparins for VTE prophylaxis following this surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hamidreza Yazdi
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Arvin Eslami
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran.
| | - Ali Torkaman
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Omid Elahifar
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Amir Kasaeian
- Digestive Diseases Research Center, Digestive Diseases Research Institute; Research Center for Chronic Inflammatory Diseases; Clinical Research Development Unit, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shaya Alimoghadam
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Rojina Alimoghadam
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Mansour Abolghasemian
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran.
- University of Alberta, Alberta, Canada.
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Wang Z, Tenzing N, Xu Q, Liu H, Ye Y, Wen Y, Wuren T, Cui S. Apoptosis is one cause of thrombocytopenia in patients with high-altitude polycythemia. Platelets 2023; 34:2157381. [PMID: 36597012 DOI: 10.1080/09537104.2022.2157381] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 01/05/2023]
Abstract
High-altitude polycythemia (HAPC) can occur in individuals who are intolerant to high-altitude hypoxia. In patients with HAPC, erythrocytosis is often accompanied by a decrease in platelet count. Chronic hypoxia can increase the incidence of arteriovenous thrombosis and the risk of bleeding during antithrombotic treatment due to thrombocytopenia; therefore, understanding the cause of thrombocytopenia can reduce the risk of treatment-related bleeding. In this study, we examined platelet production and apoptosis to understand the cause of thrombocytopenia in patients with HAPC. The classification of myeloid-derived megakaryocytes (MKs) in HAPC patients was mainly granular MKs rather than mature MKs, suggesting impaired differentiation and maturation. However, the total number of MKs and newly generated reticulated platelets in the peripheral blood increased, indicating sufficient platelet generation in HAPC thrombocytopenia. Increased platelet apoptosis may be one of the causes of thrombocytopenia. Platelet activation and GP1bα pathway activation induced by thrombin and von Willebrand factor can lead to platelet apoptosis. Platelet production was not reduced in patients with HAPC, whereas platelet apoptosis was associated with thrombocytopenia. These findings provide a rationale for considering the bleeding risk in HAPC patient while treating thrombotic diseases.
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Affiliation(s)
- Zhuoya Wang
- Research Center for High Altitude Medicine, Qinghai University, Xining, China.,Department of Qinghai University, Key Laboratory of Application and Foundation for High Altitude Medicine Research in Qinghai Province, Xining, China.,Gerontology Department, Qinghai University Affiliated Hospital, Xining, China
| | - Noryung Tenzing
- Gerontology Department, Qinghai University Affiliated Hospital, Xining, China
| | - Qiying Xu
- Research Center for High Altitude Medicine, Qinghai University, Xining, China.,Department of Qinghai University, Key Laboratory of Application and Foundation for High Altitude Medicine Research in Qinghai Province, Xining, China.,Gerontology Department, Qinghai University Affiliated Hospital, Xining, China
| | - Huifang Liu
- Research Center for High Altitude Medicine, Qinghai University, Xining, China.,Department of Qinghai University, Key Laboratory of Application and Foundation for High Altitude Medicine Research in Qinghai Province, Xining, China.,Gerontology Department, Qinghai University Affiliated Hospital, Xining, China
| | - Yi Ye
- Research Center for High Altitude Medicine, Qinghai University, Xining, China.,Department of Qinghai University, Key Laboratory of Application and Foundation for High Altitude Medicine Research in Qinghai Province, Xining, China
| | - Yi Wen
- Department of General Surgery & Pancreatic Injury and Repair Key Laboratory of Sichuan Province, The General Hospital of Western Theater Command (Chengdu Military General Hospital), Chengdu, China
| | - Tana Wuren
- Research Center for High Altitude Medicine, Qinghai University, Xining, China.,Department of Qinghai University, Key Laboratory of Application and Foundation for High Altitude Medicine Research in Qinghai Province, Xining, China
| | - Sen Cui
- Gerontology Department, Qinghai University Affiliated Hospital, Xining, China
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Stake IK, Matheny LM, Comfort SM, Dornan GJ, Haytmanek CT, Clanton TO. Outcomes Following Repair of Achilles Midsubstance Tears: Percutaneous Knotless Repair vs Open Repair. Foot Ankle Int 2023; 44:499-507. [PMID: 37272593 DOI: 10.1177/10711007231160998] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Optimum treatment for acute Achilles tendon rupture results in high mechanical strength, low risk of complications, and return to preinjury activity level. Percutaneous knotless repair is a minimally invasive technique with promising results in biomechanical studies, but few comparison clinical studies exist. Our study purpose was to compare functional outcomes and revision rates following acute Achilles tendon rupture treated between percutaneous knotless repair and open repair techniques. METHODS Patients 18 years or older with an acute Achilles tendon rupture, treated by a single surgeon with either open repair or percutaneous knotless repair, and more than 2 years after surgery were assessed for eligibility. Prospective clinical data were obtained from the data registry and standard electronic medical record. Additionally, the patients were contacted to obtain current follow-up questionnaires. Primary outcome measure was Foot and Ankle Ability Measure (FAAM) activities of daily living (ADL). Secondary outcome measures were FAAM sports, 12-Item Short Form Health Survey (SF-12), Tegner activity scale, patient satisfaction with outcome, complications, and revisions. Postoperative follow-up closest to 5 years was used in this study. RESULTS In total, 61 patients were included in the study. Twenty-four of 29 patients (83%) in the open repair group and 28 of 32 patients (88%) in the percutaneous knotless repair group completed the questionnaires with average follow-up of 5.8 years and 4.2 years, respectively. We found no significant differences in patient-reported outcomes or patient satisfaction between groups (FAAM ADL: 99 vs 99 points, P = .99). Operative time was slightly longer in the percutaneous knotless repair group (46 vs 52 minutes, P = .02). Two patients in the open group required revision surgery compared to no patients in the percutaneous group. CONCLUSION In our study, we did not find significant differences in patient-reported outcomes or patient satisfaction by treating Achilles tendon midsubstance ruptures with percutaneous knotless vs open repair. LEVEL OF EVIDENCE Level IlI, retrospective cohort study.
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Affiliation(s)
- Ingrid K Stake
- Steadman Philippon Research Institute, Vail, CO, USA
- Department of Orthopedic Surgery, Ostfold Hospital Trust, Norway
| | - Lauren M Matheny
- Steadman Philippon Research Institute, Vail, CO, USA
- School of Data Science and Analytics, Kennesaw State University, Atlanta, Georgia
| | | | | | - C Thomas Haytmanek
- Steadman Philippon Research Institute, Vail, CO, USA
- The Steadman Clinic, Vail, CO, USA
| | - Thomas O Clanton
- Steadman Philippon Research Institute, Vail, CO, USA
- The Steadman Clinic, Vail, CO, USA
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Zhu Q, Duan H, Liu Z, Li Y, Zhang Y, Shen L, Huang Y. The incidence and risk factors of perioperative cardiac complications in noncardiac major surgery in high-altitude areas: A prospective trial in Tibet autonomous region, China. Front Cardiovasc Med 2023; 10:1158711. [PMID: 37077733 PMCID: PMC10106712 DOI: 10.3389/fcvm.2023.1158711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 02/04/2023] [Accepted: 03/17/2023] [Indexed: 04/05/2023] Open
Abstract
BackgroundThe risk of perioperative cardiac complications (PCCs) in patients living in high-altitude areas may increase with more adverse clinical outcomes due to the special geographical environment, which has not yet been studied. We aimed to determine the incidence and analyze risk factors for PCCs in adult patients undergoing major noncardiac surgery in the Tibet Autonomous Region.MethodsThis prospective cohort study enrolled resident patients from high-altitude areas receiving major noncardiac surgery in Tibet Autonomous Region People's Hospital in China. Perioperative clinical data were collected, and the patients were followed up until 30 days after surgery. The primary outcome was PCCs during the operation and within 30 days after the surgery. Logistic regression was used to build the prediction models for PCCs. A receiver operating characteristic (ROC) curve was used to evaluate the discrimination. A prognostic nomogram was constructed to generate a numerical probability of PCCs for patients undergoing noncardiac surgery in high-altitude areas.ResultsAmong the 196 patients living in high-altitude areas involved in this study, 33 (16.8%) suffered PCCs perioperatively and within 30 days after surgery. Eight clinical factors were identified in the prediction model, including older age (P = 0.028), extremely high altitude above 4,000 m (P = 0.442), preoperative metabolic equivalent (MET) < 4 (P = 0.153), history of angina within 6 months (P = 0.037), history of great vascular disease (P = 0.073), increased preoperative high sensitivity C-reactive protein (hs-CRP) (P = 0.072), intraoperative hypoxemia (P = 0.025) and operation time >3 h (P = 0.043). The area under the curve (AUC) was 0.766 (95% confidence interval: 0.785–0.697). The score calculated from the prognostic nomogram predicted the risk of PCCs in high-altitude areas.ConclusionThe incidence of PCCs in resident patients living in high-altitude areas who underwent noncardiac surgery was high, and the risk factors included older age, high altitude above 4,000 m, preoperative MET < 4, history of angina within 6 months, history of great vascular disease, increased preoperative hs-CRP, intraoperative hypoxemia, and operation time >3 h. The prognostic nomogram of this study could help to assess the PCCs for patients in high-attitude areas undergoing noncardiac surgery.Clinical Trial RegistrationClinicalTrials.gov ID: NCT04819698.
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Affiliation(s)
- Qianmei Zhu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hanyu Duan
- Department of Anesthesiology, Tibet Autonomous Region People’s Hospital, Lhasa, China
| | - Zijia Liu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Correspondence: Zijia Liu Labaciren
| | - Yi Li
- Department of Anesthesiology, Tibet Autonomous Region People’s Hospital, Lhasa, China
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Le Shen
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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9
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Venous thromboembolism in patients with surgically treated ankle fractures. Arch Orthop Trauma Surg 2023; 143:1237-1242. [PMID: 34757461 DOI: 10.1007/s00402-021-04192-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 07/26/2021] [Accepted: 09/24/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES In patients with rotational ankle fracture, we compare the rate of venous thromboembolism development between patients who received chemoprophylaxis vs those patients that received none. DESIGN Retrospective cohort study. SETTING Level I trauma center. PATIENTS/PARTICIPANTS Between 2014 and 2018, we identified 483 patients with rotational ankle fracture that had no VTE risk factors, were under 70 years of age, and had an isolated injury. INTERVENTION Chemoprophylaxis vs no chemoprophylaxis after open reduction internal fixation of a rotational ankle fracture. MAIN OUTCOME MEASUREMENTS Development of VTE was the primary outcome. Secondary outcomes included wound problems, infection, hematoma, or non-union. RESULTS There were 313 patients that received no prophylaxis and 170 patients that received chemoprophylaxis after operative fixation of an isolated ankle fracture. Demographics including age, gender, body mass index, and ASA class were similar between groups. The rate of DVT/PE was 3.5% in those without DVT prophylaxis, and 4.1% in those on DVT prophylaxis with no significant differences found (p = 0.8). There was no significant difference in wound complication (no VTE prophylaxis-3.7% vs VTE prophylaxis-2.5%, p = 0.7) or infection rates (no VTE prophylaxis-3.8% vs VTE prophylaxis 4.1%, p = 1.0) between groups. CONCLUSIONS No difference was detected in the rate of symptomatic DVT or PE in patients based on chemoprophylaxis. Our results support the conclusion that the use of chemoprophylaxis may remain surgeon preference and based on patient risk factors for VTE development. LEVEL OF EVIDENCE Level III-retrospective cohort study.
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10
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Walocha D, Bogdan P, Gordon AM, Magruder ML, Conway CA, Razi AE, Choueka J. Risk factors for the development of a peri-prosthetic joint infection up to 2 Years following primary reverse shoulder arthroplasty. J Orthop 2023; 35:69-73. [PMID: 36411844 PMCID: PMC9674881 DOI: 10.1016/j.jor.2022.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 06/06/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
Abstract
Background Reverse shoulder arthroplasty (RSA) has become commonly used to treat glenohumeral osteoarthritis (GHOA), of which complications such as peri-prosthetic joint infections (PJIs) may develop. The objective of this study was to compare patient demographics of those who did and did not develop PJIs within 2 years after primary RSA for GHOA and identify risk factors for this sequela. Methods A nationwide database was queried from 2005 to 2014 for Medicare patients treated with primary RSA (International Classification of Disease (ICD-9) procedural code 81.88) for GHOA. Patients who developed PJIs within 2-years of primary RSA defined the study group, whereas those who were devoid of infections represented the comparison group. Our study consisted of 51,824 patients, of which 879 (1.69%) developed a PJI. Patient demographics comprising the Elixhauser comorbidity index (ECI) were compared using Chi-Square analyses. Multivariable logistic regression models were used to compute the odds-ratios (OR) of patient-specific factors associated with acquiring a PJI within 2 years after RSA. P values less than 0.002 were significant. Results Patients developing a PJI had higher mean ECI (8 vs. 6; p < 0.0001). The greatest risk factors for developing PJIs within 2-years following RSA were male sex (OR: 2.10, 95%CI: 1.81-2.43, p < 0.0001), pathologic weight loss (OR: 1.78, 95%CI: 1.45-2.17, p < 0.0001), iron deficiency anemia (OR: 1.75, 95%CI: 1.49-2.06, p < 0.0001), morbid obesity (OR: 1.52, 95%CI: 1.21-1.88, p = 0.0001), rheumatoid arthritis (OR: 1.32, 95%CI: 1.13-1.54, p = 0.0003), arrhythmias (OR: 1.26, 95%CI 1.09-1.46, p = 0.001), and depressive disorders (OR: 1.23, 95%CI 1.06-1.43, p = 0.001). Conclusions The greatest risk factors for PJIs within 2 years of primary RSA included male sex; additional modifiable risk factors included iron deficiency anemia, pathologic weight loss, and obesity. Preoperative screening can help to identify modifiable risk factors and alter management for high-risk patients to potentially minimize PJIs.
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Affiliation(s)
- Daniel Walocha
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, USA
- State University of New York (SUNY) Downstate, College of Medicine, Brooklyn, NY, USA
| | - Paulina Bogdan
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, USA
- State University of New York (SUNY) Downstate, College of Medicine, Brooklyn, NY, USA
| | - Adam M. Gordon
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, USA
| | - Matthew L. Magruder
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, USA
| | - Charles A. Conway
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, USA
| | - Afshin E. Razi
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, USA
| | - Jack Choueka
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, USA
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11
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Swiggett SJ, Mannino A, Vakharia RM, Ehiorobo JO, Roche MW, Mont MA, Erez O. Impact of Biological Sex on Complications, Lengths of Stay, Readmission Rates, and Costs of Care Following Primary Total Knee Arthroplasty. J Knee Surg 2022; 35:1306-1311. [PMID: 33545731 DOI: 10.1055/s-0041-1723014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Indexed: 02/07/2023]
Abstract
The impact of gender on total knee arthroplasty (TKA) postoperative complications, readmission rates, and costs of care has not been often evaluated. Therefore, the purpose of this study was to investigate which sex had higher rates of: (1) medical complications; (2) implant complications; (3) lengths of stay (LOSs); (4) readmission rates; and (5) costs after TKA. A query was performed using an administrative claims database from January 1, 2005, to March 31, 2015. Patients who had TKAs were identified using International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes. Males and females were filtered separately and matched according to age and various medical comorbidities leading to 1,590,626 patients equally distributed. Primary outcomes analyzed included 90-day medical complications, LOSs, 90-day readmission rates, in addition to day of surgery and total global 90-day episode of care costs. Pearson's chi-square analyses were used to compare medical complications and readmission rates. Welch's t-tests were used to test for significance in matching outcomes and costs. A p-value of less than 0.01 was considered statistically significant. Males had a smaller risk of complications than women (1.35 vs. 1.40%, p < 0.006) and higher rates of implant-related complications (2.28 vs. 1.99%, p < 0.0001). Mean LOSs were lower for males: 3.16 versus 3.34 days (p < 0.0001). The 90-day readmission rates were higher in men (9.67 vs. 8.12%, p < 0.0001). This study demonstrated that males undergoing primary TKA have lower medical complications and shorter LOSs then their female counterparts. However, males have higher implant-related complications, readmission rates, and costs of care.
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Affiliation(s)
- Samuel J Swiggett
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Angelo Mannino
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Rushabh M Vakharia
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Joseph O Ehiorobo
- Department of Orthopaedic Surgery, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Martin W Roche
- Department of Orthopaedic Surgery, Holy Cross Hospital, Ft. Lauderdale, Florida
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, Manhattan, New York
| | - Orry Erez
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
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12
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Yang H, Yang G, Xu M, Zhao Y, He S, Wang Q, Wen Y, Huang C, Wu J, Ren C, Yang Y, He S. Impact of high altitude on the incidence of postoperative venous thromboembolism and its genetic susceptibility: A meta-analysis and systematic review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 838:156632. [PMID: 35691358 DOI: 10.1016/j.scitotenv.2022.156632] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Academic Contribution Register] [Received: 09/17/2021] [Revised: 06/07/2022] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The effect of high-altitude (HA) on venous thromboembolism (VTE) and its mechanism remains ambiguous. To clarify this, we aimed to conduct a meta-analysis and systematic review to evaluate the incidence of VTE at HA and comparatively low altitude (LA) and figure out the intrinsic risk factors such as susceptibility genes of patients with VTE at HA. METHODS We selected studies that explored the risk factors for HA and VTE by searching PubMed, Embase, and Web of Science to analyze the impact of HA on VTE. All relevant studies before August 2021 were screened using the terms ([high altitude] OR [plateau] OR [mountain]) AND ([venous thromboembolism] OR [deep vein thrombosis] OR [pulmonary embolism]). Latest studies on the gene of HA-VTE patients were also summarized and analyzed. RESULTS Fifteen studies were eventually assessed, and the overall numbers of subjects with and without VTE were 1475 and 286,926 respectively. The overall incidence of VTE, deep vein thrombosis (DVT) and pulmonary embolism (PE) in the HA group was significantly higher than that in the LA group (P < 0.01). The overall incidence of VTE, DVT and PE in the HA group was significantly higher than that in the LA group at 30 days post operation (P < 0.05, P < 0.05 and P < 0.01, respectively). At 90 days post operation, incidence of VTE and PE in the HA group was higher than that in the LA group (P < 0.01and P < 0.01, respectively), but there was no difference in the incidence of DVT (P = 0.07). Regarding endogenous factors, the analysis of genes in patients with HA-VTE revealed numerous targeted genes such as ANG, ACE, lncRNA-LINC00 659/UXT-AS1 and GP4. CONCLUSIONS We observed a significant association between HA and the overall incidence of VTE and that at 30/90 days post operation, indicating that HA may be a risk factor for VTE.
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Affiliation(s)
- Haihong Yang
- Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Guan Yang
- Department of Pain, The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Meiling Xu
- Department of Geriatrics, The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Yuanyuan Zhao
- The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Shengdong He
- The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Qiwu Wang
- The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Yi Wen
- The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Chen Huang
- The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Jianping Wu
- Department of Neurosurgery, The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Chao Ren
- The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Yongxiang Yang
- Department of Neurosurgery, The General Hospital of Western Theater Command, Chengdu 610083, China.
| | - Siyi He
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, Chengdu 610083, China.
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13
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Jones CA, Broggi MS, Holmes JS, Gerlach EB, Goedderz CJ, Ibnamasud SH, Hernandez-Irizarry R, Schenker ML. High Altitude as a Risk Factor for Venous Thromboembolism in Tibial Plateau Fractures. Cureus 2022; 14:e24388. [PMID: 35637832 PMCID: PMC9132220 DOI: 10.7759/cureus.24388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Academic Contribution Register] [Accepted: 04/18/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Tibial plateau fractures are often significant injuries that can require complex surgical interventions with prolonged perioperative immobilization, thereby increasing the risk of developing venous thromboembolic (VTE) events, specifically, deep vein thrombosis (DVT) and pulmonary embolism (PE). Risk stratification is paramount for guiding VTE prophylaxis. Although high altitude has been suggested to create a prothrombotic state, virtually no studies have explored its clinical effects in lower extremity trauma. The purpose of this study was to compare surgical fixation of tibial plateau fractures at high and low altitudes and its effects on post-operative VTE development. Methods: The Truven MarketScan claims database was used to retrospectively identify patients who underwent surgical fixation of isolated and closed tibial plateau fractures using Current Procedural Terminology (CPT) codes over a 10-year period. Extraneous injuries were excluded using the International Classification of Diseases, 10th edition (ICD-10), and CPT codes. Patient demographics, comorbidities, and DVT chemoprophylaxis prescriptions were obtained. Patients were partitioned into high altitude (>4000 feet) or low altitude (<100 feet) cohorts based on the zip codes of their surgery locations. One-to-one matching and univariate analysis were used to assess and control any baseline discrepancies between cohorts; multivariate regression was then performed between cohorts to determine the odds ratios (OR) for developing VTEs post-operatively. Results: There were 7,832 patients included for analysis. There was no statistical difference between high and low altitude cohorts in developing VTEs within 30 days post-operatively. Higher altitudes were associated with increased odds of developing DVT (OR 1.21, p = 0.043) and PE (OR 1.27, p = 0.037) within 90 days post-operatively. Conclusions: Surgical fixation of tibial plateau fractures is associated with an increased risk of developing VTEs at high altitudes within 90 days post-operatively. Understanding such risk factors in specific orthopaedic patient populations is essential for optimizing DVT prophylaxis protocols. Further studies should investigate this relationship and the role of DVT prophylaxis regimens in this population.
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14
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Easwaran R, Khan M, Sancheti P, Shyam A, Bhandari M, Ranawat AS, Thakkar S, Parikh S, Musahl V, Joglekar S, J Deshmukh A, Plancher K, Verma N, McAllister D, Verdonk P, Lustig S, Chandrateya A, Smigleiski R, Solayar G, Chernchujit B, Yung P, Budhiparama N, Hoshino Y, White N, Parker D, Clatworthy M, Brown C, Manzary M, Rajan D, Narvekar A, Tapasvi S, Pardiwala D, Panigrahi R, Arumugam S, Kapoor V, Mody B, Maheshwari J, Dahiya V, Joseph C, Laddha M, Rajgopal A. Prophylaxis for preventing venous thromboembolism in knee arthroscopy and soft tissue reconstruction: consensus statements from an international panel of experts. Knee Surg Sports Traumatol Arthrosc 2022; 30:3634-3643. [PMID: 35435469 PMCID: PMC9013735 DOI: 10.1007/s00167-022-06973-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 02/17/2022] [Accepted: 03/29/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE There is a lack of consensus regarding need for Venous Thrombo Embolism (VTE) prophylaxis following arthroscopic knee surgery and open soft tissue knee reconstruction. Clear cut guidelines like ones for trauma surgery and arthroplasty do not exist and the published literature is limited to case reports with a few society guidelines. Given this lack of consensus, we conducted a modified Delphi questionnaire of international experts to provide recommendations on this topic. METHODS The consensus statements were generated using an anonymised 3 round modified Delphi questionnaire, sent to an international panel of 38 knee surgeons, with an 80% agreement being set as the limit for consensus. The responses were analysed using descriptive statistics with measures like mode, median and box plots. Feedback was provided to all panelists based on responses from the previous rounds to help generate the consensus. RESULTS Six consensus statements were generated after the three rounds of Delphi. Patient factors, prolonged surgery duration and family history of thrombogenic events emerged as the main points to be taken into consideration for prophylaxis. CONCLUSION It was established through this study, that there exists a select group of patients undergoing arthroscopic surgery that justify the usage of VTE prophylaxis. The expert responses to most of the questions in different scenarios favoured usage of VTE prophylaxis based on patient factors like advanced age, past history of VTE, smoking, oral contraceptive use etc. LEVEL OF EVIDENCE: Level V.
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Affiliation(s)
- Raju Easwaran
- Shree Meenakshi Orthopedics and Sports Medicine Clinic, B H 41 East, Shalimar Bagh, New Delhi, 110088, India.
- Department of Arthroscopy and Sports Injuries, Max Super-Speciality Hospital Shalimar Bagh, New Delhi, India.
| | - Moin Khan
- Sports Medicine and Shoulder Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - Parag Sancheti
- Sancheti Institute for Orthopaedics and Rehabilitation and PG College, Pune, India
| | - Ashok Shyam
- Sancheti Institute for Orthopedics and Rehabilitation, Pune, India
| | - Mohit Bhandari
- Chair, Department of Surgery, McMaster University, Hamilton, Canada
| | - Anil S Ranawat
- Knee Division of SMI, Hospital for Special Surgery, New York, USA
| | - Savyasachi Thakkar
- Johns Hopkins Orthopaedics, Hip and Knee Reconstruction Surgery, Columbia, USA
| | - Shital Parikh
- Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Volker Musahl
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, USA
| | - Siddharth Joglekar
- Orthopedic Service, VA Central California Health Care System, Fresno, CA, USA
- UCSF Fresno Orthopedic Residency Program, Fresno, USA
| | | | - Kevin Plancher
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, NY, USA
- Weill Cornell Medical College, New York, USA
- Orthopaedic Foundation, Stamford, CT, USA
- Plancher Orthopaedics and Sports Medicine, New York, USA
| | - Nikhil Verma
- Division of Sports Medicine, Sports Medicine Fellowship, Rush University Medical Center, Midwest Orthopedics at Rush, Chicago, USA
| | - David McAllister
- Sports Medicine Service, Vice Chair of Academic Affairs, Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, USA
- UCLA Department of Athletics, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Peter Verdonk
- Orthopaedic Center Antwerp, Antwerp, Belgium
- Department of Orthopaedic Surgery, Antwerp University, Antwerp, Belgium
| | - Sebastien Lustig
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, Lyon, France
| | - Amit Chandrateya
- Princess of Wales Hospital Bridgend, Cwm Taf Morgannwg University Health Board, Bridgend, UK
| | - Robert Smigleiski
- Orthopaedics and Sports Medicine, Department at LIFE Institute, LIFE Institute Biological Treatment Centre, Warsaw, Poland
| | - Gandhi Solayar
- Orthopaedic Specialist Centre, Subang Jaya, Selangor, Malaysia
| | - Bancha Chernchujit
- Department of Orthopedics, Thammasat University Hospital, Khlong Nueng, Thailand
| | - Patrick Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong, China
| | - Nicolaas Budhiparama
- School of Vocational Studies and Department of Orthopaedics and Traumatology, School of Medicine, University of Airlangga, Jl. Mayjend. Prof. Dr. Moestopo, Jawa Timur, Indonesia
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine, Medistra Hospital, Jakarta, Indonesia
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, School of Medicine, Kobe University, Kobe, Japan
| | | | - David Parker
- Sydney Orthopaedic Research Institute, Chatswood, Australia
| | | | - Charlie Brown
- International Knee and Joint Centre, Abu Dhabi, United Arab Emirates
| | - Mojieb Manzary
- Orthopedic Services, Johns Hopkins Aramco Health Care Center, Dhahran, Saudi Arabia
- Department of Orthopedics, Johns Hopkins University School of Medicine, Dhahran, Saudi Arabia
| | - David Rajan
- Ortho One-Orthopaedic Speciality Centre, Coimbatore, India
| | - Abhay Narvekar
- P D Hinduja Hospitals Mumbai, Global Hospital Parel, Mumbai, India
| | | | - Dinshaw Pardiwala
- Arthroscopy Service, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | - Ranjit Panigrahi
- PG Dept of Orthopaedics, Hitech Medical College and Hospital, Bhubaneswar, Odisha, India
- Kalinga Super Speciality Hospital, Bhubaneswar, Odisha, India
| | - S Arumugam
- Centre for Sports Science, Sri Ramachandra Institute of Higher Education and Research (Deemed University), Chennai, India
| | - Vikash Kapoor
- Medica Superspeciality Hospital, Medica Hospitals, Kolkata, India
| | - Bharat Mody
- Welcare Hospital, Atladra-Vadsar Ring Road, Atladra, Vadodara, Gujarat, India
| | - Jitender Maheshwari
- Knee and Shoulder Service, Department of Orthopaedics, Sitaram Bharatiya Hospital, New Delhi, India
| | - Vivek Dahiya
- Adult Reconstruction Lower Limb, Institute of Musculoskeletal Disorders and Orthopaedics, Medanta, Gurugram, India
| | - Clement Joseph
- Arthroscopy and Sports Medicine, Asian Joint Reconstruction Institute, SIMS, Chennai, India
| | | | - Ashok Rajgopal
- Institute of Musculoskeletal Diseases and Orthopaedics, Medanta Medicity, Gurugram, Haryana, India
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15
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Khan NZ, Hamaway SN, Weisberg MD, Horn AR, Vakharia RM, Razi AE. A Higher Altitude Is Associated with Increased Incidence of Infections following Primary Total Hip Arthroplasty. Hip Pelvis 2021; 33:219-224. [PMID: 34938691 PMCID: PMC8654588 DOI: 10.5371/hp.2021.33.4.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 02/14/2021] [Accepted: 03/15/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to evaluate whether patients undergoing primary total hip arthroplasty (THA) at a higher elevation have higher rates of: 1) in-hospital length of stay (LOS); 2) surgical site infections (SSIs); 3) periprosthetic joint infections (PJIs); and 4) costs. Materials and Methods The Medicare claims database was used to identify patients who underwent primary THA at an altitude higher than 4,000 feet (ft). High-altitude patients were matched to patients who underwent primary THA at an altitude less than 100 ft, yielding 24,958 and 124,765 patients respectively. Outcomes that were assessed included in-hospital LOS, SSIs, PJIs, and costs of care. A P-value less than 0.001 was considered statistically significant. Results Patients in the study group had significantly longer in-hospital LOS (4 days vs 3 days, P<0.0001). In addition, patients in the study group had a significantly higher incidence and odds of developing SSIs (1.16% vs 0.86%; odds ratio [OR], 1.34; P<0.0001) and PJIs (0.91% vs 0.58%; OR, 1.56; P<0.0001) within 90-days following the index procedure, compared to matched controls. Higher altitude patients incurred higher day of surgery ($16,139.76 vs $15,279.42; P<0.0001) and 90-day costs ($18,647.51 vs $16,401.62; P<0.0001). Conclusion This study demonstrated that primary THA procedures performed at an elevation higher than 4,000 ft are associated with longer in-hospital LOS, higher rates of SSIs, PJIs, and costs of care. Orthopedists and other healthcare professionals can use this information to provide adequate education for these patients regarding the potential complications that may occur following their procedure.
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Affiliation(s)
- Nabil Z Khan
- Department of Orthopedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Stefan N Hamaway
- Department of Orthopedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Miriam D Weisberg
- Department of Orthopedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Andrew R Horn
- Department of Orthopedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Rushabh M Vakharia
- Department of Orthopedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Afshin E Razi
- Department of Orthopedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
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16
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Sylla MM, Gruffi L, Roth ES, Rosato FE, Wong CHJ, Razi AE. How Does Iron Deficiency Anemia Impact Outcomes following Revision Total Hip Arthroplasty? Hip Pelvis 2021; 33:140-146. [PMID: 34552891 PMCID: PMC8440132 DOI: 10.5371/hp.2021.33.3.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 04/09/2021] [Revised: 05/10/2021] [Accepted: 05/31/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose Studies have shown the prevalence of iron deficiency anemia (IDA) increasing worldwide, and currently the literature is limited on the impact of IDA on outcomes following revision total hip arthroplasty (RTHA). Therefore, the purpose of this study was to determine whether IDA patients undergoing RTHA have longer: 1) in-hospital lengths of stay (LOS); 2) medical complications; and 3) costs of care. Materials and Methods A retrospective query of a nationwide administrative claims database was performed. Using Boolean command operations, the study group consisted of all patients in the database undergoing RTHA with IDA; whereas, patients without IDA served as controls. To reduce the effects of confounding, study group patients were matched to controls in a 1:5 ratio by age, sex, and medical comorbidities yielding 92,948 patients with (n=15,508) and without (n=77,440) IDA undergoing revision THA. A P-value less than 0.001 was considered statistically significant. Results IDA patients were found to have significantly longer in-hospital LOS (5 days vs. 4 days, P<0.0001). Additionally, the study showed IDA patients were found to higher incidence and odds of (73.84% vs. 11.77%, OR 5.04, P<0.0001) 90-day medical complications. IDA patients also incurred high 90-day episode of care costs ($25,597.51 vs. $20,085.70, P<0.0001). Conclusion After adjusting for age, sex, and medical comorbidities this study of over 92,000 patients demonstrated IDA is associated with longer in-hospital LOS, complications, and costs of care. Future studies should compare the duration and severity of IDA on outcomes.
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Affiliation(s)
- Mohamed M Sylla
- State University of New York (SUNY) Downstate College of Medicine, Brooklyn, NY, USA.,Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Lauren Gruffi
- State University of New York (SUNY) Downstate College of Medicine, Brooklyn, NY, USA.,Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Eric S Roth
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Francis E Rosato
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Che Hang Jason Wong
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Afshin E Razi
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
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17
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A Matched Control Analysis on the Effects of Alcohol Use Disorder After Primary Total Knee Arthroplasty in Medicare Patients. J Am Acad Orthop Surg 2021; 29:e593-e600. [PMID: 32991387 DOI: 10.5435/jaaos-d-20-00466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 05/01/2020] [Accepted: 07/24/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Several studies have found the negative impact of alcohol use disorder (AUD), most notably coagulation derangements. We sought to investigate the effects of AUD after primary total knee arthroplasty (TKA) for (1) postoperative complications, (2) lengths of stay, and (3) costs of care. METHODS This was a retrospective database analysis of Medicare patients with AUD undergoing primary TKA performed between 2005 and 2014. Patients with AUD were matched to controls in a 1:5 ratio by age, sex, and medical comorbidities. The query yielded 354,690 TKA patients: 59,126 with AUD and 295,564 without AUD. RESULTS Patients with AUD had significantly greater odds ratio (OR) of medical complications, including venous thromboembolism (VTE) within 90 days (OR: 1.41, P < 0.0001) and at 1 year (OR: 1.51, P < 0.0001) and greater 2-year implant-related complications after primary TKA. Furthermore, patients with AUD had significantly longer lengths of stay (4 versus 3 days, P < 0.0001) and incurred a significantly higher episode of care costs ($15,569.76 versus $13,763.06, P < 0.0001). DISCUSSION The present study demonstrated a significant association between AUD and the development of VTE. We hope this research will aid in risk stratification and tailoring of VTE chemoprophylaxis and postoperative management in this at-risk group after TKA. LEVEL OF EVIDENCE Level III.
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18
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Bilateral pulmonary embolism without deep venous thrombosis was observed after knee arthroscopy: a case report. BMC Musculoskelet Disord 2021; 22:383. [PMID: 33894744 PMCID: PMC8070294 DOI: 10.1186/s12891-021-04266-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 01/12/2021] [Accepted: 04/15/2021] [Indexed: 12/30/2022] Open
Abstract
Background Symptomatic pulmonary embolism (PE) after knee arthroscopy is extremely rare. If the embolism is not treated promptly, the patient may die. Bilateral pulmonary embolism with associated pulmonary infarct without concomitant deep vein thrombosis has never been reported following routine knee arthroscopy. Case presentation A 50-year-old female patient with no other risk factors other than hypertension, obesity, varicose veins in the ipsilateral lower extremities and elevated triglyceride (TG) presented to our ward. She had experienced sudden chest tightness, polypnea and fainting after going to the bathroom the morning of the second postoperative day and received emergency medical attention. Colour ultrasonography of the extremities showed no deep vein thrombosis. Lung computed tomography angiography (CTA) showed multiple embolisms scattered in both pulmonary artery branches. Thus, emergency interventional thrombolysis therapy was performed, followed by postoperative symptomatic treatment with drugs with thrombolytic, anticoagulant and protective activities. One week later, lung CTA showed a significant improvement in the PEs compared with those in the previous examination. Since the aetiology of PE and no obvious symptoms were discerned, the patient was discharged. Conclusion Although knee arthroscopy is a minimally invasive and quick procedure, the risk factors for PE in the perioperative period should be considered and fully evaluated to enhance PE detection. Moreover, a timely diagnosis and effective treatment are important measures to prevent and cure PE after knee arthroscopy. Finally, clear guidelines regarding VTE thromboprophylaxis following knee arthroscopy in patients with a low risk of VTE development are needed.
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Swiggett SJ, Vakharia AM, Ehiorobo JO, Vakharia RM, Roche MW, Mont MA, Choueka J. Impact of depressive disorders on primary total shoulder arthroplasties: a matched control analysis of 113,648 Medicare patients. Shoulder Elbow 2021; 13:181-187. [PMID: 33897849 PMCID: PMC8039756 DOI: 10.1177/1758573220916846] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 11/15/2019] [Accepted: 03/09/2020] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The purpose of this study was to investigate whether patients with depressive disorders undergoing primary total shoulder arthroplasty have higher rates of (1) in-hospital lengths of stay, (2) readmission rates, (3) medical complications, and (4) implant-related complications. METHODS A retrospective query was performed using a national claims database. Study group patients were matched to controls in a 1:5 ratio according to age, sex, and medical comorbidities. The query yielded 113,648 patients who were with (n = 18,953) and without (n = 94,695) depressive disorders. Pearson's χ2 analyses were used to compare patient demographics. Logistic regression analyses were used to calculate odds-ratios of complications and readmission rates. Welch's t-tests were used to test for significance for in-hospital lengths of stay. A p-value less than 0.003 was considered statistically significant. RESULTS Study group patients had significantly longer in-hospital lengths of stay (2.7 days versus 2.3 days; p < 0.0001). Patients who have depressive disorders had higher incidences and odds of readmissions (9.4 versus 6.15%; odds-ratio: 1.6, p < 0.0001), medical complications (2.7 versus 0.9%; odds-ratio: 3.0, p < 0.0001), and implant-related complications (6.1 versus 2.4%; odds-ratio: 2.59, p < 0.0001) compared to controls. CONCLUSION Depressive disorder patients have longer in-hospital lengths of stay and increased odds of readmissions and complications following primary total shoulder arthroplasty.
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Affiliation(s)
- Samuel J Swiggett
- Department of Orthopedic Surgery,
Maimonides Medical Center, Brooklyn, USA,Samuel J Swiggett, Maimonides Medical
Center, 4802, 10th Avenue Brooklyn, NY 11219, USA.
| | - Ajit M Vakharia
- Department of Orthopedic Surgery, Case
Western Reserve University Hospital, Cleveland, USA
| | - Joseph O Ehiorobo
- Department of Orthopedic Surgery,
Northwell Health, Lenox Hill Hospital, New York, USA
| | | | - Martin W Roche
- Holy Cross Hospital, Orthopedic Research
Institute, Ft Lauderdale, USA
| | - Michael A Mont
- Department of Orthopedic Surgery,
Northwell Health, Lenox Hill Hospital, New York, USA,Department of Orthopaedic Surgery,
Cleveland Clinic Hospital, Cleveland, USA
| | - Jack Choueka
- Department of Orthopedic Surgery,
Maimonides Medical Center, Brooklyn, USA
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20
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Garrido D, Garrido S, González M, Pullas G. Letter to the Editor: Pulmonary Embolism Mortality in the Elderly Population Living at High Altitude in Ecuador. High Alt Med Biol 2020; 22:110-112. [PMID: 33047979 DOI: 10.1089/ham.2020.0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- David Garrido
- Posgrado de Hematología, Universidad de la Republica, Montevideo, Uruguay
| | - Santiago Garrido
- Unidad de Cuidados Intensivos, Hospital General del IESS, Ibarra, Ecuador
| | | | - Gonzalo Pullas
- Servicio de Cirugía Vascular y Angiología, Hospital de Especialidades de las Fuerzas Armadas N°1, Quito, Ecuador
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21
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Plancher KD, Chan JJ, Bishai SK, Silane M, Ibrahim TF, Petterson SC. DVT and Pulmonary Embolism Following Knee Arthroscopy: The Role of Genetic Predisposition and Autoimmune Antibodies: A Report of 3 Cases. JBJS Case Connect 2020; 10:e0514. [PMID: 32649112 DOI: 10.2106/jbjs.cc.19.00514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/14/2022]
Abstract
Deep vein thrombosis (DVT) after arthroscopy has been considered a rare event; however, recent studies using ultrasound and venography have shown that the incidence of DVTs is underestimated. CASES:: This report describes 3 patients with DVT and/or PE after knee arthroscopy who were attributed to a genetic predisposition of hypercoagulability unknown to the patient and surgeon. CONCLUSIONS:: Genetic predisposition and autoimmune antibodies may play a role in the development of DVT after knee arthroscopy. We recommend focused questions regarding family history be added to the standard DVT/PE preoperative questionnaire.
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Affiliation(s)
- Kevin D Plancher
- 1Albert Einstein College of Medicine, Department of Orthopaedic Surgery, Bronx, New York 2Plancher Orthopaedics and Sports Medicine, New York, New York 3Orthopaedic Foundation, Stamford, Connecticut 4Michigan State University College of Osteopathic Medicine, East Lansing, Michigan 5Weill-Cornell Medical School, Department of Orthopaedic Surgery, New York, New York
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22
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Sodhi N, Anis HK, Acuña AJ, Vakharia RM, Piuzzi NS, Higuera CA, Roche MW, Mont MA. The Effects of Opioid Use on Thromboembolic Complications, Readmission Rates, and 90-Day Episode of Care Costs After Total Hip Arthroplasty. J Arthroplasty 2020; 35:S237-S240. [PMID: 32197965 DOI: 10.1016/j.arth.2020.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 11/29/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate whether opioid use disorder (OUD) patients are at greater odds than non-opioid use disorder (NUD) patients in developing (1) thromboembolic complications; (2) readmission rates; and (3) costs of care. METHODS All patients with a 90-day history of OUD before total hip arthroplasty (THA) were identified from a national database. Patients were matched 1:5 to controls by age, gender, Elixhauser Comorbidity Index scores, and high-risk medical comorbidities, yielding 38,821 patients with (n = 6398) and without (n = 31,883) OUD. Multivariate logistic regression analyses were performed to compare the risks of developing venous thromboembolism (deep vein thrombosis and/or pulmonary embolism) 90 days after the index procedure, 90-day readmission rates, and total global 90-day episode of care costs. RESULTS Patients with a history of OUD were found to be at greater risk for 90-day venous thromboembolisms (2.38 vs. 1.07%; OR: 2.25, 95% CI: 1.86-2.73, P < .0001) compared with matched NUD patients. Specifically, OUD patients were at greater risk for both deep vein thromboses (2.13 vs. 0.87%; OR: 2.46, 95% CI: 2.00-3.03, P < .001) and pulmonary embolism (0.61 vs. 0.27%; OR: 2.24, 95% CI: 1.53-3.27, P < .0001). In addition, patients with OUD were at an increased risk for 90-day readmission (28.68 vs. 22.62%; OR: 1.37, 95% CI: 1.29-1.46, P < .0001) compared with controls. Primary THA patients with OUD incurred a 14.72% higher cost of care ($20,610.65 vs. $17,964.58) compared with NUD patients. CONCLUSION These findings demonstrate that primary THA patients with a history of OUD are at greater risks for thromboembolic complications, readmissions, and higher costs of care in the 90-day postoperative period.
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Affiliation(s)
- Nipun Sodhi
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, Northwell Health, New York, NY
| | - Hiba K Anis
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | | | - Rushabh M Vakharia
- Department of Orthopaedic Surgery, Holy Cross Hospital, Ft. Lauderdale, FL
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | | | - Martin W Roche
- Department of Orthopaedic Surgery, Holy Cross Hospital, Ft. Lauderdale, FL
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
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23
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Vakharia RM, Naziri Q, Sodhi N, Scuderi GR, Mont MA, Roche MW. Comparison Study of Patient Demographics, Risk Factors, and Lengths of Stay for Postoperative Ileus After Primary Total Knee Arthroplasty. J Arthroplasty 2020; 35:1397-1401. [PMID: 31866253 DOI: 10.1016/j.arth.2019.11.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 06/27/2019] [Revised: 11/23/2019] [Accepted: 11/27/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Postoperative ileus is a potential complication after orthopedic surgery, which has not been well studied after total knee arthroplasty (TKA). The aims of this study were to analyze rates of postoperative ileus; patient demographic profiles; in-hospital lengths of stay (LOS); and patient-related risk factors for postoperative ileus after primary TKA. METHODS A query was performed from January 1, 2005 to March 31, 2014 using the Medicare Standard Analytical Files. Patients who underwent primary TKA and developed postoperative ileus within 3 days after their index procedure were identified. Patients who did not develop ileus represented controls. Primary outcomes analyzed and compared included patient demographics, risk factors, and in-hospital LOS. A P value less than .05 was considered statistically significant. RESULTS Ileus patients were older, more likely to be male, and had higher Elixhauser-Comorbidity Index scores (8 vs 6; P < .0001) compared with controls. Male patients (odds ratio [OR], 2.12; P < .0001), patients with preoperative electrolyte/fluid imbalance (OR, 3.40; P < .001), patients older than 70 years (OR, 1.62-2.33; P < .015), and body mass indices greater than 30 kg/m2 (OR, 1.79-2.00; P < .001) were at the greatest risk of developing ileus. In addition, ileus patients had significantly longer in-hospital LOS (5.42 vs 3.22 days; P < .001). CONCLUSION The study demonstrated differences in patient demographics, patient-related risk factors, and an increased in-hospital LOS for ileus patients after primary TKA. The study is important as it can allow orthopedists to properly identify and optimize patients with certain risk factors to potentially mitigate this adverse event from occurring.
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Affiliation(s)
| | - Qais Naziri
- Department of Orthopedic Surgery, Cleveland Clinic Florida, Weston, FL
| | - Nipun Sodhi
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY
| | - Giles R Scuderi
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY
| | - Michael A Mont
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY; Department of Orthopedic Surgery, Cleveland Clinic Hospital, Cleveland, OH
| | - Martin W Roche
- Holy Cross Hospital, Orthopedic Research Institute, Fort Lauderdale, FL
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24
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Vakharia RM, Ehiorobo JO, Sodhi N, Swiggett SJ, Mont MA, Roche MW. Effects of Depressive Disorders on Patients Undergoing Primary Total Knee Arthroplasty: A Matched-Control Analysis. J Arthroplasty 2020; 35:1247-1251. [PMID: 31902616 DOI: 10.1016/j.arth.2019.12.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 08/22/2019] [Revised: 11/23/2019] [Accepted: 12/09/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Studies evaluating the effects of depressive disorders in patients undergoing primary total knee arthroplasty (TKA) are sparse. Therefore, the purpose of this study is to investigate whether patients who have depressive disorders undergoing primary TKA have higher rates of (1) in-hospital lengths of stay (LOS), (2) readmission rates, (3) medical complications, (4) implant-related complications, and (5) costs of care. METHODS Patients with depressive disorders undergoing primary TKA were identified and matched to controls in a 1:5 ratio by age, sex, and comorbidities. The query yielded 138,076 patients who had (n = 23,061) or did not have (n = 115,015) depressive disorders. Primary outcomes analyzed included in-hospital LOS, 90-day readmission rates, 90-day medical complications, 2-year implant-related complications, and costs of care. A P value less than .003 was considered statistically significant. RESULTS Patients who have depressive disorders had significantly longer in-hospital LOS (6.2 days vs 3.1 days; P < .0001). Additionally, study group patients had a higher incidence and odds of readmissions (15.5% vs 12.1%; odds ratio [OR], 1.33; P < 001), medical complications (5.0% vs 1.6%; OR, 3.34; P < .0001), and implant-related complications (3.3% vs 1.7%; OR; 1.97; P < .0001) Study group patients also incurred significantly higher day of surgery ($12,356.59 vs $10,487.71; P < .0001) and 90-day costs ($23,386.17 vs $22,201.43; P < .0001). CONCLUSION After adjusting for age, sex, and comorbidities, this study demonstrated that patients who have depressive disorders have increased rates of in-hospital LOS, readmissions, complications, and cost. The study is useful in allowing orthopedists to adequately educate patients of potential complications which may occur.
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Affiliation(s)
| | - Joseph O Ehiorobo
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Samuel J Swiggett
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Martin W Roche
- Orthopedic Research Institute, Holy Cross Hospital, Ft. Lauderdale, FL
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25
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Vakharia RM, Sodhi N, Anis HK, Ehiorobo JO, Mont MA, Roche MW. Patients Who Have Cannabis Use Disorder Have Higher Rates of Venous Thromboemboli, Readmission Rates, and Costs Following Primary Total Knee Arthroplasty. J Arthroplasty 2020; 35:997-1002. [PMID: 31973970 DOI: 10.1016/j.arth.2019.11.035] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 09/08/2019] [Revised: 11/06/2019] [Accepted: 11/22/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Studies have shown that cannabis can interfere with hematological parameters and platelet morphology. The purpose of this study is to investigate whether patients with cannabis use disorder undergoing primary total knee arthroplasty (TKA) have higher rates of (1) venous thromboemboli (VTEs); (2) readmissions; and (3) costs. METHODS Study group patients undergoing primary TKA were identified from a large, nationwide database. Patients who had a history of VTEs, deep vein thromboses (DVTs), pulmonary emboli (PEs), and coagulopathies before their TKA were excluded. Study group patients were matched to controls in a 1:4 ratio by age, sex, a comorbidity index, and medical comorbidities. The query yielded 18,388 patients (cannabis = 3680; controls = 14,708). Outcomes analyzed included rates of 90-day VTEs, DVTs, and PEs, in addition to 90-day readmissions and costs. A P value less than .01 was considered statistically significant. RESULTS Patients who have cannabis use disorder were found to have significantly higher incidence and odds (2.79% vs 1.78%; odds ratio [OR], 1.58; P < .0001) of VTEs, DVTs (2.41% vs 1.44%; OR, 1.68; P < .0001), and PEs (0.97% vs 0.62%; P = .01). Readmissions were significantly higher (27.03% vs 23.18%; OR, 1.22; P < .0001) in patients who have cannabis use disorder. Patients with cannabis use disorder have significantly higher day of surgery ($14,024.88 vs $12,127.49; P < .0001) and 90-day costs ($19,155.45 vs $16,315.00; P < .0001). CONCLUSION This study found that patients who have a cannabis use disorder have higher rates of thromboembolic complications, readmission rates, and costs following primary TKA compared to a matched cohort.
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Affiliation(s)
- Rushabh M Vakharia
- Holy Cross Hospital, Orthopaedic Research Institute, Fort Lauderdale, FL
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Hiba K Anis
- Department of Orthopaedic Surgery, Cleveland Clinic Hospital, Cleveland, OH
| | - Joseph O Ehiorobo
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY; Department of Orthopaedic Surgery, Cleveland Clinic Hospital, Cleveland, OH
| | - Martin W Roche
- Holy Cross Hospital, Orthopaedic Research Institute, Fort Lauderdale, FL
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26
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Vakharia RM, Sabeh KG, Cohen-Levy WB, Sodhi N, Mont MA, Roche MW. Opioid Disorders Are Associated With Thromboemboli Following Primary Total Knee Arthroplasty. J Arthroplasty 2019; 34:2957-2961. [PMID: 31451391 DOI: 10.1016/j.arth.2019.07.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 06/26/2019] [Revised: 07/24/2019] [Accepted: 07/30/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Opioid use disorder (OUD) is defined as a problematic pattern of opioid abuse and dependency leading to problems or distress. The purpose of this study is to investigate whether OUD patients undergoing primary total knee arthroplasty (TKA) have higher rates of venous thromboembolisms (VTEs), readmissions, and costs of care. METHODS Patients undergoing TKA with OUD were identified and matched to controls in a 1:4 ratio according to age, gender, comorbidity index, and comorbidities within the Medicare database. Ninety-day VTEs, 90-day readmissions, and costs of care were compared. A P-value less than .01 was considered statistically significant. RESULTS The study yielded 54,480 patients with (n = 10,929) and without (n = 43,551) OUD undergoing primary TKA. Matching was successful as there were no significant differences in baseline characteristics. OUD patients were found to have greater odds of VTEs (odds ratio 2.27, P < .0001) 90 days following primary TKA. OUD patients were found to have greater odds of 90-day readmissions (odds ratio 1.39, P < .0001) in addition to incurring higher day of surgery ($13,360.73 vs $11,911.94, P < .0001) and 90-day costs ($18,380.89 vs $15,565.57, P < .0001) compared to controls. CONCLUSION After adjusting for confounders, this analysis of 54,480 patients identified that patients with OUD have higher rates of VTEs, readmissions, and costs following primary TKA. In addition to using these data to help educate and counsel patients, the study should be used to help further regulate and control opioid prescriptions written by healthcare professionals.
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Affiliation(s)
| | - Karim G Sabeh
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA
| | - Wayne B Cohen-Levy
- Department of Orthopedic Surgery, University of Miami Hospital, Miami, FL
| | - Nipun Sodhi
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY
| | - Michael A Mont
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY; Department of Orthopaedic Surgery, Cleveland Clinic Hospital, Cleveland, OH
| | - Martin W Roche
- Holy Cross Hospital, Orthopedic Research Institute, Fort Lauderdale, FL
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27
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Donnally CJ, Vakharia AM, Sheu JI, Vakharia RM, Damodar D, Shenoy K, Gjolaj JP. High Altitude Is an Independent Risk Factor for Developing a Pulmonary Embolism, but Not a Deep Vein Thrombosis Following a 1- to 2-Level Lumbar Fusion. Global Spine J 2019; 9:729-734. [PMID: 31552154 PMCID: PMC6745647 DOI: 10.1177/2192568219828349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Indexed: 11/25/2022] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To identify if a 1- to 2-level posterior lumbar fusion at higher altitude is an independent risk factor for postoperative deep vein thrombosis (DVT) and pulmonary embolism (PE). METHODS A national Medicare database was queried for all patients undergoing 1- to 2-level lumbar fusions from 2005 to 2014. Those with a prior history of DVT, PE, coagulopathy, or peripheral vascular complications were excluded to better isolate altitude as the dependent variable. The groups were matched 1:1 based on age, gender, and comorbidities to limit potential cofounders. Using ZIP codes of the hospitals where the procedure occurred, we separated our patients into high (>4000 feet) and low (<100 feet) altitudes to investigate postoperative rates of DVTs and PEs at 90 days. RESULTS Compared with lumbar fusions performed at low-altitude centers, patients undergoing the same procedure at high altitude had significantly higher PE rates (P = .010) at 90 days postoperatively, and similar rates of 90-day postoperative DVTs (P = .078). There were no significant differences in age or comorbidities between these cohorts due to our strict matching process (P = 1.00). CONCLUSION Spinal fusions performed at altitudes >4000 feet incurred higher PE rates in the first 90 days compared with patients receiving the same surgery at <100 feet but did not incur higher rates of postoperative DVTs.
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Affiliation(s)
- Chester J. Donnally
- University of Miami Hospital, Miami, FL, USA,Chester J. Donnally III, Department of
Orthopaedics, University of Miami Hospital, 1400 NW 12th Avenue, Miami, FL
33136, USA.
| | | | - Jonathan I. Sheu
- University of Miami Leonard M. Miller School of Medicine, Miami, FL,
USA
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28
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Trunk AD, Rondina MT, Kaplan DA. Venous Thromboembolism at High Altitude: Our Approach to Patients at Risk. High Alt Med Biol 2019; 20:331-336. [PMID: 31479310 DOI: 10.1089/ham.2019.0049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 12/31/2022] Open
Abstract
Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is a prevalent disorder that confers substantial cardiovascular morbidity and, in serious cases, death. VTE has a complex and incompletely understood etiopathogenesis with genetic, acquired, and environmental risk factors. As the focus of this review, one environmental risk factor, which may interact with other risk factors such as hereditary and/or acquired thrombophilias, is travel to high altitude (HA), although current evidence is limited. As guidelines do not directly address this topic, we will discuss the epidemiology of HA-VTE, review the putative mechanisms for thrombosis at HA, and discuss our clinical approach to both risk stratification and counseling, including specific pharmacologic and nonpharmacologic recommendations for patients with elevated VTE risk before they travel to HA.
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Affiliation(s)
- Andrew D Trunk
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Matthew T Rondina
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah.,Department of Internal Medicine and GRECC, George E. Wahlen VAMC, Salt Lake City, Utah.,Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah.,Molecular Medicine Program, Eccles Institute of Human Genetics, University of Utah, Salt Lake City, Utah
| | - David A Kaplan
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah
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29
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Shang C, Wuren T, Ga Q, Bai Z, Guo L, Eustes AS, McComas KN, Rondina MT, Ge R. The human platelet transcriptome and proteome is altered and pro-thrombotic functional responses are increased during prolonged hypoxia exposure at high altitude. Platelets 2019; 31:33-42. [PMID: 30721642 DOI: 10.1080/09537104.2019.1572876] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 12/12/2022]
Abstract
Exposure to hypoxia, through ascension to high altitudes (HAs), air travel, or human disease, is associated with an increased incidence of thrombosis in some settings. Mechanisms underpinning this increased thrombosis risk remain incompletely understood, and the effects of more sustained hypoxia on the human platelet molecular signature and associated functional responses have never been examined. We examined the effects of prolonged (≥2 months continuously) hypobaric hypoxia on platelets isolated from subjects residing at HA (3,700 meters) and, for comparison, matched subjects residing under normoxia conditions at sea level (50 meters). Using complementary transcriptomic, proteomic, and functional methods, we identified that the human platelet transcriptome is markedly altered under prolonged exposure to hypobaric hypoxia at HA. Among the significantly, differentially expressed genes (mRNA and protein), were those having canonical roles in platelet activation and thrombosis, including membrane glycoproteins (e.g. GP4, GP6, GP9), integrin subunits (e.g. ITGA2B), and alpha-granule chemokines (e.g. SELP, PF4V1). Platelets from subjects residing at HA were hyperactive, as demonstrated by increased engagement and adhesion to fibrinogen, fewer alpha granules by transmission electron microscopy, increased circulating PF4 and ADP, and significantly enhanced clot retraction. In conclusion, we identify that prolonged hypobaric hypoxia exposure due to HA alters the platelet transcriptome and proteome, triggering increased functional activation responses that may contribute to thrombosis. Our findings may also have relevance across a range of human diseases where chronic hypoxia, platelet activation, and thrombosis are increased.
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Affiliation(s)
- Chunxiang Shang
- Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai, China.,Oncology Department, The Fifth Hospital of Qinghai Provinces, Xining, Qinghai, China
| | - Tana Wuren
- Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai, China.,Departments of Internal Medicine and Pathology, University of Utah, Salt Lake City, UT, USA
| | - Qing Ga
- Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai, China
| | - Zhenzhong Bai
- Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai, China
| | - Li Guo
- The University of Utah Molecular Medicine Program, University of Utah, Salt Lake City, UT, USA
| | - Alicia S Eustes
- Departments of Internal Medicine and Pathology, University of Utah, Salt Lake City, UT, USA.,The University of Utah Molecular Medicine Program, University of Utah, Salt Lake City, UT, USA
| | - Kyra N McComas
- Departments of Internal Medicine and Pathology, University of Utah, Salt Lake City, UT, USA
| | - Matthew T Rondina
- Departments of Internal Medicine and Pathology, University of Utah, Salt Lake City, UT, USA.,The University of Utah Molecular Medicine Program, University of Utah, Salt Lake City, UT, USA.,Hematological Department, George E. Wahlen VAMC GRECC, Salt Lake City, UT, USA
| | - Rili Ge
- Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai, China
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Nemeth B, Cannegieter SC. Venous thrombosis following lower-leg cast immobilization and knee arthroscopy: From a population-based approach to individualized therapy. Thromb Res 2019; 174:62-75. [DOI: 10.1016/j.thromres.2018.11.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 07/19/2018] [Revised: 11/09/2018] [Accepted: 11/28/2018] [Indexed: 01/19/2023]
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Damodar D, Vakharia R, Vakharia A, Sheu J, Donnally CJ, Levy JC, Kaplan L, Munoz J. A higher altitude is an independent risk factor for venous thromboembolisms following total shoulder arthroplasty. J Orthop 2018; 15:1017-1021. [PMID: 30377388 DOI: 10.1016/j.jor.2018.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 08/09/2018] [Accepted: 09/30/2018] [Indexed: 01/24/2023] Open
Abstract
Introduction High altitudes lead to physiological changes that may predispose to venous thromboembolisms (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE). No prior study has evaluated if there is also a higher risk of VTEs after total shoulder arthroplasties (TSAs) performed at higher elevations compared to lower elevations. The purpose of this study was to identify if undergoing TSA at a higher altitude center (>4000 feet above sea level) is an independent risk factor for a postoperative VTE. Methods A retrospective review was performed from 2005 to 2014 using the Medicare Standard Analytical Files of the Pearl Diver database (Pearl Diver Technologies, West Conshohocken, PA, USA). The inclusion criteria for the study group consisted of all patients in the database undergoing primary TSAs at an altitude above 4000 feet. Patients were queried using the International Classification of Disease 9th revision codes (ICD-9). All patients undergoing primary TSA were queried using ICD-9 procedure code 81.80. Patients were filtered using the zip codes of the hospitals where the procedure occurred and were separated into high (>4,000 ft) and low (<100 ft) altitudes. Patients undergoing TSA in altitudes <100 ft represented the control group. Patients with a history of VTE, DVT, PE, and coagulation disorders were excluded from the study. Patients in the study group were randomly matched 1:1 according to age, gender, and comorbidities. Two mutually exclusive cohorts were formed and rates of VTE, DVT, and PE were analyzed and compared. Statistical analysis was performed using the programming language R (University of Auckland, New Zealand). An alpha value less than 0.05 was considered statistically significant. Results In the first 30 postoperative days, patients undergoing TSA at a higher altitude experienced a significantly higher rate of PEs (odds ratio [OR], 39.5; P = <0.001) when compared to similar patients at lower altitudes. This trend was also present for PE (OR, 2.02; P < 0.03) at 90 days postoperatively. Conclusion TSAs performed at higher altitudes (>4000 feet) have a higher rate of acute postoperative PEs in the first 30 days and 90 days postoperatively when compared to matched patients receiving the same surgery at a lower altitude (<100 feet). TSA patients at high altitude should be counseled on these increased risks.
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Affiliation(s)
- Dhanur Damodar
- University of Miami Hospital, Department of Orthopedic Surgery, 1400 N.W. 12th Ave, Miami, FL, 33136, USA
| | - Rushabh Vakharia
- Holy Cross Hospital, Orthopedic Research Institute, 5597 North Dixie Highway, Ft. Lauderdale, FL, 33308, USA
| | - Ajit Vakharia
- Morehouse School of Medicine, 720 Westview Dr., 30310, Atlanta, GA, USA
| | - Jon Sheu
- University of Miami Hospital, Department of Orthopedic Surgery, 1400 N.W. 12th Ave, Miami, FL, 33136, USA
| | - Chester J Donnally
- University of Miami Hospital, Department of Orthopedic Surgery, 1400 N.W. 12th Ave, Miami, FL, 33136, USA
| | - Jonathan C Levy
- Holy Cross Hospital, Orthopedic Research Institute, 5597 North Dixie Highway, Ft. Lauderdale, FL, 33308, USA
| | - Lee Kaplan
- University of Miami Hospital, Department of Orthopedic Surgery, 1400 N.W. 12th Ave, Miami, FL, 33136, USA
| | - Julianne Munoz
- University of Miami Hospital, Department of Orthopedic Surgery, 1400 N.W. 12th Ave, Miami, FL, 33136, USA
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Weinberg I, Giri J, Kolluri R, Arcelus JI, Falgá C, Soler S, Braester A, Bascuñana J, Gutiérrez-Guisado J, Monreal M. Characteristics, treatment patterns and outcomes of patients presenting with venous thromboembolic events after knee arthroscopy in the RIETE Registry. J Thromb Thrombolysis 2018; 46:551-558. [PMID: 30196344 DOI: 10.1007/s11239-018-1736-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Indexed: 10/28/2022]
Abstract
Knee arthroscopy is the most common orthopedic procedure worldwide. While incidence of post-arthroscopy venous thromboembolic events (VTE) is low, treatment patterns and patient outcomes have not been described. Patients from the "Registro Informatizado Enfermedad TromboEmbolica" who had confirmed post-arthroscopy VTE were compared to patients with provoked, post bone-fracture, and to patients with unprovoked VTE. Baseline characteristics, presenting signs and symptoms, treatment and outcomes including recurrent VTE, bleeds or death were compared. A total of 101 patients with post-arthroscopy VTE and 19,218 patients with unprovoked VTE were identified. Post-arthroscopy patients were younger (49.5 vs. 66 years, P < 0.0001) and had less history of VTE [5.9% vs. 20%, OR 0.26 (0.11-0.59)]. Among patients with isolated DVT, there were fewer proximal DVT in the post-arthroscopy group [40% vs. 86%, OR 0.11 (0.06-0.19)]. Treatment duration was shorter in the post-arthroscopy group (174 ± 140 vs. 311 ± 340 days, P < 0.0001) and more often with DOAC [OR 3.67 (1.95-6.89)]. Recurrent VTE occurred in 6.18 (1.96-14.9) and 11.9 (11.0-12.8) per 100 patient years [HR 0.52 (0.16-1.26)] after treatment in the post-arthroscopy and unprovoked groups, respectively. Recurrent VTE occurred in 5.17 (1.31-14.1) per 100 patient years in a separate post bone-fracture group (n = 147), also not statistically different than the post-arthroscopy recurrence rate. After anticoagulation cessation, some patients post-knee arthroscopy develop VTE. While our small sample size precludes drawing firm conclusions, this signal should warrant further research into the optimal treatment duration for these patients, as some patients may be at increased risk for long-term recurrence.
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Affiliation(s)
- Ido Weinberg
- Vascular Medicine, Division of Cardiology, Fireman Vascular Center, Massachusetts General Hospital, 55 Fruit Street, GRB-852G, Boston, MA, 02114, USA.
| | - Jay Giri
- Division of Cardiology, Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Raghu Kolluri
- OhioHealth Vascular Institute, Ohio Health, Columbus, OH, USA
| | - Juan Ignacio Arcelus
- Department of General Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Conxita Falgá
- Department of Internal Medicine, Hospital de Mataró, Barcelona, Spain
| | - Silvia Soler
- Department of Internal Medicine, Hospital Olot i Comarcal de la Garrotxa, Girona, Spain
| | - Andrei Braester
- Department of Haematology, Galilee Medical Center, Nahariya, Israel
| | - José Bascuñana
- Department of Internal Medicine, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Javier Gutiérrez-Guisado
- Department of Internal Medicine, Hospital Monográfico ASEPEYO, Madrid, Spain.,Universidad Francisco de Vitoria, Madrid, Spain
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.,Universidad Católica de Murcia, Murcia, Spain
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Damodar D, Donnally CJ, Sheu JI, Law TY, Roche MW, Hernandez VH. A Higher Altitude Is an Independent Risk Factor for Venous Thromboembolisms After Total Hip Arthroplasty. J Arthroplasty 2018; 33:2627-2630. [PMID: 29691178 DOI: 10.1016/j.arth.2018.03.045] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 01/26/2018] [Revised: 02/22/2018] [Accepted: 03/17/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND High altitudes lead to physiological changes that may predispose to venous thromboembolisms (VTEs) including deep vein thrombosis and pulmonary embolism (PE). No prior study has evaluated if there is also a higher risk of VTEs for total hip arthroplasties (THAs) performed at higher elevations. The purpose of this retrospective study was to identify if undergoing THA at a higher altitude center (>4000 feet above sea level) is an independent risk factor for a postoperative VTE. METHODS A thorough evaluation of the Pearl Diver Database was performed for patients undergoing THAs from 2005 to 2014. Using International Classification of Diseases Ninth Edition facilitated in ascertaining patients who underwent THA. Using the ZIP codes of the hospitals where the procedure occurred, we separated our groups into high-altitude (>4000 ft) and low-altitude (<100 ft) groups. RESULTS In the first 30 postoperative days, patients undergoing THA at a higher altitude experienced a significantly higher rate of PEs (odds ratio, 1.74; P = .003) when compared to similar patients at lower altitudes. This trend was also present for PE (odds ratio, 1.59; P < .001) at 90 days postoperatively. CONCLUSION THAs performed at higher altitudes (>4000 feet) have a higher rate of acute postoperative PEs in the first 30 days and also 90 days postoperatively when compared to matched patients receiving the same surgery at a lower altitude (<100 feet). THA patients at high altitude should be counseled on these increased risks; however, owing to retrospective nature and confounders, prospective studies are necessary to explore this outcome in more detail.
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Affiliation(s)
- Dhanur Damodar
- Department of Orthopedic Surgery, University of Miami Hospital, Miami, Florida
| | - Chester J Donnally
- Department of Orthopedic Surgery, University of Miami Hospital, Miami, Florida
| | - Jonathan I Sheu
- Department of Education, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Tsun Y Law
- Department of Orthopedic Surgery, Holy Cross Hospital, Orthopedic Research Institute, Fort Lauderdale, Florida
| | - Martin W Roche
- Department of Orthopedic Surgery, Holy Cross Hospital, Orthopedic Research Institute, Fort Lauderdale, Florida
| | - Victor H Hernandez
- Department of Orthopedic Surgery, University of Miami Hospital, Miami, Florida
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Fang CH, Liu H, Zhang JH, Yan SG. An unusual case of symptomatic deep vein thrombosis and pulmonary embolism after arthroscopic meniscus surgery. BMC Musculoskelet Disord 2018; 19:19. [PMID: 29343245 PMCID: PMC5773136 DOI: 10.1186/s12891-017-1919-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 11/09/2017] [Accepted: 12/14/2017] [Indexed: 11/10/2022] Open
Abstract
Background Although thrombosis complication is rare after arthroscopic meniscus surgery, deep vein thrombosis and pulmonary embolism can be fatal. The associated risk factors and whether anticoagulant prevention after arthroscopic knee surgery is necessary have not reach consensus. Here we present a case of deep vein thrombosis and pulmonary embolism after a common arthroscopic meniscectomy. Case presentation The patient had no risk factors except ipsilateral leg varicose veins. She present swell at knee and calf from postoperative 3 weeks, and developed dyspnea, palpitation, and nausea on 33th day, pulmonary embolism was confirmed with CT angiography at emergency department. After thrombolysis and anticoagulation therapy were administered, the patient improved well and discharged. And the intravenous ultrasound confirmed thrombosis of popliteal vein and small saphenous vein. Who don’t have common risk factors for venous thromboembolism. Conclusions Despite the low incidence of thromboembolic complications after simple arthroscopy surgery, its life-threatening and devastating property make clinicians rethink the necessity of thromboprophylaxis and importance of preoperative relative risk factors screening.
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Affiliation(s)
- Chao-Hua Fang
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88 Jiefang Road, Hangzhou, 310009, People's Republic of China.,Department of Joint Surgery, the 6th Hospital of Ningbo, Ningbo, 315000, Zhejiang, People's Republic of China
| | - Hua Liu
- Department of Joint Surgery, the 6th Hospital of Ningbo, Ningbo, 315000, Zhejiang, People's Republic of China
| | - Jun-Hui Zhang
- Department of Joint Surgery, the 6th Hospital of Ningbo, Ningbo, 315000, Zhejiang, People's Republic of China.
| | - Shi-Gui Yan
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88 Jiefang Road, Hangzhou, 310009, People's Republic of China.
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