The COVID rebound effect: Incidence of tendon rupture surgeries in the peripandemic COVID era in a single tertiary academic institution

Objectives:The COVID-19 pandemic led to increased sedentary behavior and BMIs during 2020, which may decondition musculotendinous units and lead to increased risk for injury.Our hypothesis is as patients return to pre-COVID levels of activity, we hypothesize that there will be a resultant rebound increase in tendon ruptures.Methods:The electronic medical record was queried for current procedural terminology codes for tendon ruptures (Achilles, patella, quadriceps, hamstring, distal biceps, triceps, and pectoralis major) from January 2017 to December 2021 at a single academic urban center. Data was reviewed to ensure only acute tendon rupture repairs were included. The years 2017 – 2019 was used as a proxy for pre- COVID rates, 2020 as a proxy for the COVID quarantine, and 2021 as a proxy for “Post-COVID” activity. Univariate analysis was performed for comparative data.Results:A total of 1879 patients (82.8% male, mean age 47.8 years) who sustained tendon injuries and underwent surgical repair were identified. There were 589 (31.3%) Achilles tendon repairs, 181 (9.6%) patella tendon repairs, 414 (22.0%) quadriceps tendon repairs, 100 (5.3%) hamstring tendon repairs, 397 (21.1%) distal biceps repairs, 105 (5.6%) triceps repairs, and 93 (4.9%) pectoralis tendon repairs. The total number of tendon injuries per year was: 2017 – 357 (19.0%), 2018 – 380 (20.2%), 2019 – 380 (20.2%), 2020 – 308 (16.4%), 2021 – 454 (24.2%). The rates in 2017, 2018, and 2019 were within 1% of each other, but there was a 3.8% decrease in rate of tendon injuries from 2019 to 2020, and a 7.8% increase in rate of tendon injuries from 2020 to 2021 (Figure 1). When analyzed by quarter, linear regression model demonstrated a statistically significant increase in case counts over the period from Q2 2020 to Q2 2021 (β = 21.20; 95% CI = 13.62 - 28.78, p-value < 0.01).Conclusions:A “COVID rebound” of tendon rupture repairs in 2021 from a prolonged period of inactivity during 2020 occurred at a single academic center. As patients return to pre-COVID levels of activity that may be unsuitable to their deconditioned state, health care providers, should counsel patients appropriately on return to activity or sport following long periods of induced inactivity. : This study presents important epidemiologic information on musculotendinous injury rates during the COVID-19 pandemic, that can help providers counsel patients when returning to their former baseline levels of physical activity.

(1,3)- β-D-glucan (BDG) testing is one of the noninvasive tests to aid diagnosis of invasive fungal infections (IFIs). The study results have been heterogenous, and diagnostic performance varies depending on the risks for IFI. Thus, it is important to select appropriate patients for BDG testing to prevent false-positive results. An algorithmic diagnostic stewardship intervention was instituted at a single academic medical center to improve BDG test utilization. The BDG test order in the electronic health record was replaced with the BDG test request order, which required approval to process the actual test order. The approval criteria were (1) immunocompromised or intensive care unit patient and (2) on empiric antifungal therapy, or inability to undergo invasive diagnostic procedures. A retrospective observational study was conducted to evaluate the efficacy of the intervention by comparing the number of BDG tests performed between 1 year pre- and post-intervention. Safety was assessed by chart review of the patients for whom BDG test requests were deemed inappropriate and rejected. The number of BDG tests performed per year decreased by 85% from 156 in the pre-intervention period to 24 in the post-intervention period. The average monthly number of BDG tests performed was significantly lower between those periods (P = .002). There was no delay in IFI diagnosis or IFI-related deaths in the patients whose BDG test requests were rejected. The sustained effectiveness of the intervention was observed for 5 years. Institution of the diagnostic stewardship intervention successfully and safely improved BDG test utilization.

This study aims to define the incidence of infection with upper airway stimulation (UAS) devices requiring explantation in a single academic center and identify factors that may influence the risk of infection. A database of patients who underwent UAS at a single tertiary referral academic center from 2017 to 2021 was retrospectively reviewed to identify patients who developed surgical site infections, with and without subsequent explantation. Additional data for cases complicated by infection was extracted from the electronic medical record (EMR) and included: demographic information, medical history, complications and management, and overall outcomes. In March 2021, 2 modifications to infection control protocols were implemented: double skin preparation with Betadine and chlorhexidine, and MRSA decolonization. Statistical analysis was performed to compare infectious risk before and after these protocol changes. In the study period, 215 patients underwent UAS in the specified time period and 3 cases (1.4%) of postoperative infections were identified, all of which required explantation. The infection rate did not significantly change after modifications to the surgical prep protocol (P = .52). While no significant difference in infection risk was noted after modifying infection control protocols, additional longer-term study is warranted to elucidate effective infection reduction strategies.

The clinical presentation and treatment of MOG antibody disease at a single academic center: A case series

There is an increased need for surgical trainees to acquire advanced laparoscopic skills as laparoscopy becomes the standard of care in many areas of general surgery. Since the introduction of minimally invasive surgery (MIS) fellowships, there has been a continuing debate as to whether these fellowships adversely affect general surgery resident exposure to laparoscopic cases. The aim of our study was to examine whether the introduction of an MIS fellowship negatively impacts general surgery residents' experience at a single academic center. We describe the changes following establishment of MIS fellowship at an academic center. Resident case log system from the Accreditation Council for Graduate Medical Education was queried to obtain all PGY 1-5 resident operative case logs. Two-year time period preceding and following the institution of an MIS fellowship at our institution in 2012 was compared. P values less than 0.05 were considered statistically significant. Following initiation of the MIS fellowship, an MIS service was established. The service comprised of a fellow, midlevel resident, and intern. Operative experience was examined. From 2010-2012 to 2012-2014, residents logged a total of 272 and 585 complex laparoscopic cases, respectively. There were 43 residents from 2010 to 2013 and 44 residents from 2013 to 2014. When the two time periods were compared, a trend of increased numbers for all procedures was noted, except laparoscopic GYN/genito-urinary procedures. Average percent increase in complex general surgery procedures was 249±179.8%. Following establishment of a MIS fellowship, reported cases by residents were higher or similar to those reported nationally for laparoscopic procedures. Institution of an MIS fellowship had a favorable effect on general surgery resident operative education at a single academic training center. Residents may benefit from the presence of a fellowship at an academic center because they are able to participate in an increased number of complex laparoscopic cases.

Introduction: The practice of endovascular therapy has evolved dramatically over the last 10 years with randomized clinical trials investigating the benefit of thrombectomy in select patient populations based on time of presentation, imaging criteria, and procedural technique. We sought to understand the benefit of thrombectomy in patients treated within the context of a clinical trial at a single academic center.Methods: Patient-level data recorded in case forms and core-lab adjudicated data were analyzed from patients enrolled in RCTs investigating the benefit of endovascular thrombectomy over medical management (IMSIII, MR RESCUE, ESCAPE, SWIFT PRIME, and DAWN) between 2007 and 2017 at a single academic referral center.Results: A total of 134 patients (intervention group, n = 81; medical group, n = 53) were identified across five clinical trials (IMSIII, n = 46; MR RESCUE, n = 4; ESCAPE, n = 24; SWIFT PRIME, n = 14; DAWN, n = 46). There were no significant differences between the treatment arm and control arm in terms of age, gender, baseline NIHSS, ASPECTS, and site of occlusion. Rates of good outcome were superior in the intervention group with early neurological recovery (NIHSS of 0–1 or increase NIHSS of 8 points at 24 h) at a higher rate of 49% vs. 17% (p = <0.001) and higher rates of functional independence (90 day mRS 0–2 of 53% vs. 26%, p = 0.002). In multivariate logistic regression analysis, lower NIHSS and younger age were predictors of good outcome. There were comparable rates of good outcome irrespective of clinical trial, imaging selection criteria (CTP vs. MRI), early vs. late time window (0–6 h vs. 6–24 h) and procedural technique (Merci vs. Solitaire/Trevo device). There were no differences in rates of sICH, PH-2 or mortality in the intervention group vs. medical group.Conclusions: At a large academic center, the benefit of endovascular therapy over medical therapy is observed irrespective of clinical trial design, patient selection or procedural technique.

Introduction: Endovascular therapy practice has evolved dramatically over the last decade. Various randomized trials have investigated the benefit of thrombectomy using different selection criteria including patient populations based on time of presentation, imaging criteria, and procedural technique. We sought to understand the benefit of thrombectomy in patients treated within the context of a clinical trial regardless of trial design at a single academic center. Methods: Data were analyzed from patients enrolled in randomized controlled trials investigating the benefit of endovascular thrombectomy over medical management (IMSIII, ESCAPE, SWIFT PRIME and DAWN) between 2007 and 2017 at a single academic referral center. Results: A total of 130 patients (intervention group, n=80; medical group, n=50) were identified across four clinical trials (IMSIII, n=46; ESCAPE, n=24; SWIFT PRIME, n=14; DAWN, n=46). There were no significant differences between the treatment arm and control arm in terms of age, gender, baseline NIHSS, baseline ASPECTS and occlusion location. There were no differences in rates of sICH, PH-2 or mortality. Rates of good outcome were superior in the intervention group with early neurological recovery (defined as NIHSS of 0-1 or drop in NIHSS of 8 points at 24 hours) at a higher rate of 53% vs 14% (p=&lt;0.001) and higher rates of functional independence (90 day mRS 0-2 of 54% vs 26%, p=0.002). In multivariate logistic regression analysis, lower NIHSS and younger age were predictors of good outcome. There were comparable rates of good outcome irrespective of clinical trial, imaging selection criteria (CTP vs MRI), early versus late time window design (0-6 hours vs 6-24 hours) and procedural technique (Merci vs Solitaire/Trevo). Conclusions: At a large academic center, the benefit of endovascular therapy over medical therapy is observed irrespective of clinical trial design, patient selection or procedural technique.

Category: Sports; Ankle Introduction/Purpose: The World Health Organization declared the outbreak of COVID-19 a pandemic on March 11, 2020, leading to lockdowns, quarantines, and increased sedentary behaviors. As the general population as well as athletes returned to their normal physical activities or sport in 2021, the risk for musculoskeletal injury increases after inactivity. Thus, the purpose of this study was (1) to investigate the rates of AATR requiring repair in a single academic center in NYC, and (2) see if a corollary exists in the NFL. Our hypothesis is that after a decrease in AATRs in 2020 from decreased physical activity due to a combination of lockdown sanctions and COVID pandemic-induced fears, there is a rebound increase in AATRs in 2021, possibly even to greater than pre-pandemic levels. Methods: All study protocols were approved by the Institutional Review Board at the senior author's institution. A retrospective search was conducted using current procedural terminology to identify the total number of Achilles acute primary repair surgeries performed from years 2017 to 2021 at a sincle academic center. NFL data was obtained from publicly available sites according to previously validated studies. Chi-square analysis was conducted between proportion of Achilles surgeries performed in 2021 and 2017-2020 at a single academic center. Additional Chi-square analysis was performed in a similar manner, however between each year and 2021. Results: A total of 588 patients who sustained AATRs and underwent primary surgical repair were identified, primarily men (75.7%, n = 445), with an average age of 43.22+-14.4 years. The incidence of the total number of AATR repairs per year was: 2017: 21.1% (n = 124), 2018: 18.7% (n = 110), 2019: 22.1% (n = 130), 2020: 14.6% (n = 86), 2021: 23.5% (n = 138), indicating a 7.5% decrease in rate of AATRs from 2019 to 2020, followed by an 8.9% increase in incidence from 2020 to 2021. Within the NFL, the number of AATRs resulting in an IR stint increased every regular season from 2019-2020: 21.2% (n = 11), to 2020-2021: 32.7% (n = 17), to this past 2021-2022 season: 46.2% (n = 24). Conclusion: The main finding of our study is a decrease in the incidence of AATRs during the height of the COVID pandemic quarantine in 2020, with a 8.9% increase in 'post-COVID' 2021 at a single academic institution. There was also a 2.9% higher incidence of AATR in 2021 compared to 'pre-COVID' normal levels when averaged between 2017 to 2019, findings that are mirrored in the NFL. This information provides important information for providers when counseling patients and athletes on return to sport in this current pandemic, especially with possible future lockdowns or quarantines due to new variants such as Omicron.

Peanut oral immunotherapy at a single academic medical center using a volume-based approach with store-purchased peanut products.

Isolated central precocious puberty (CPP) includes sporadic, familial and adoption-related forms, and the characterization of its etiology is challenging. This study investigated the prevalence and clinical characteristics of isolated CPP. This observational cohort study included all patients (n = 395) with CPP included in the database of a single academic pediatric care center over a period of 11.5 years. In total, 332 of the 395 patients (84%) had isolated forms of CPP; the proportion of male patients was lower in this group than for non-isolated CPP (4 vs 33%, P < 0.0001). These patients had sporadic (n = 228, 68.5%), familial (n = 82, 25%) or adoption-related (n = 22, 6.5%) forms. Clinical characteristics at diagnosis were similar between groups, but girls with sporadic CPP were older at referral than those with familial or adoption-related CPP (P < 0.02), and birth weight SDS was lower in adopted patients than in those from the sporadic and familial groups (P < 0.01). In the 72 families containing patients with familial forms, both recessive and dominant transmissions were observed between first-degree relatives. Potential maternal or paternal transmission was identified in two-thirds of the studied families, in similar proportions. An autosomal dominant mode of transmission with low penetrance was suggested by the high proportion of affected parents (33 of the 72 families, 46%). Clinical presentation was similar whatever the mode of inheritance. These findings highlight the need for careful monitoring of the various forms of CPP. Future studies should explore pathophysiological mechanisms, particularly for familial forms.

Context:Discoid lupus erythematosus (DLE) and human immunodeficiency virus (HIV) are both disorders of the immune system. The pathophysiology of these diseases varies greatly as DLE is characterized by an overactive immune system that attacks normal host cells, whereas HIV is characterized by an exogenous attack on the immune system that depletes it of key cell types. Although the reason is unknown, co-occurrence of DLE and HIV is rare.Aims:The goal of this study is to determine the prevalence of co-occurrence of DLE and HIV and to determine whether patients with both DLE and HIV share any clinical feature.Subjects and Methods:The medical records of all patients seen within a single academic health center over a 20-year period were reviewed to determine the prevalence of cutaneous lupus, HIV, and co-occurrence of these conditions. The charts of patients diagnosed with both conditions were further reviewed to determine similarities between them.Results:Of the 10,719 patients diagnosed with HIV and 182 patients diagnosed with cutaneous lupus, only 2 patients were diagnosed with both conditions. Both of these patients were diagnosed with DLE several years after being diagnosed with HIV. They had an undetectable HIV viral load, normal CD4 T-cell counts, and were on antiretroviral therapy when diagnosed with DLE.Conclusion:These results confirm that co-occurrence of DLE and HIV is rare. Although our study population was small, findings from these patients suggest that in HIV-positive patients, DLE manifestations occur when their HIV disease activity is minimal.

The purpose of this study was to evaluate the willingness of gender diverse people assigned female at birth with a cervix for different high-risk HPV (hrHPV) methods of cervical cancer screening (CCS). We examined provider-collected hrHPV, at-home, self-collected hrHPV, and in-clinic, self-collected hrHPV, as well as their impact on gender dysphoria and screening barriers. This cross-sectional survey study was conducted in 2024 among transgender men, non-binary, genderqueer, and agender individuals at a single academic medical center. Data from 123 participants included demographics, gender dysphoria, screening barriers, past experiences, and willingness to receive hrHPV testing. Statistical analyses identified differences in gender dysphoria, barriers to CCS, past Pap test experiences, and hrHPV testing preferences via logistic regression analyses. Most transgender men (63%) preferred at-home, self-collected hrHPV, and 37% of transgender men were unwilling to provider-collected hrHPV. Gender diverse people with gender dysphoria preferred at-home, self-collected hrHPV (60%), while those without gender dysphoria preferred alternating at-home, self-collected and provider-collected hrHPV (38%). Logistic regressions showed 78% (p < 0.005) and 53% (p < 0.001) lower odds of provider-collected hrHPV for those with gender dysphoria and screening barriers, respectively. Our findings showed that the concealment of procedural steps (Adjusted Odds Ratio = 0.01, p < 0.02), use of gendered language (AOR = 0.17, p < 0.01), and misgendering (AOR = 0.31, p < 0.05) reduced the willingness to undergo provider-collected hrHPV. However, these experiences did not show a difference between self-collected hrHPV testing methods. This is one of the largest U.S. studies assessing the preferences for hrHPV testing among gender diverse people. Our findings emphasize that transgender men prefer at-home, self-collected hrHPV, which can reduce gender dysphoria and screening barriers. This underscores the need for patient-centered screening and gender-inclusive care to help reduce disparities in CCS among gender diverse people.

Dollars for Diagnosis: A Single-Institutional Analysis of Billing for Intraoperative Transesophageal Echocardiography Examinations

OUTCOMES OF FROZEN DONOR OOCYTES COMPARED TO FRESH DONOR OOCYTES CYCLES, AN INTENT TO TREAT ANALYSIS

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