Differences In Patient-reported Outcomes Research Articles

Babcock versus Scissor Tensioning for Retropubic Mid-Urethral Slings: Comparing Two Intra-Operative Techniques Through 5 Years of Follow-Up.

The objective was to determine if mid-urethral sling (MUS) tensioning with a Mayo Scissor as a sub-urethral spacer compared with a Babcock clamp holding a loop of tape under the urethra results in differences in patient-reported outcomes and rates of repeat surgery over a 5-year follow-up. Follow-up 5 years after a randomized clinical trial, utilizing primary data collection linked to administrative health data, was carried out to create a longitudinal cohort. The primary outcome was participant-reported bothersome SUI symptoms, as defined by the Urogenital Distress Inventory (UDI-6) questionnaire. Secondary outcomes included participant-reported bothersome overactive bladder (OAB) scores, median scores of three validated urinary symptom questionnaires, and rates of subsequent surgery determined through patient report and administrative data. Two hundred and sixty (81.8%) of the original study participants provided participant-reported data at 5 years. Administrative data linkage was completed for all of the original participants (n = 318). Demographic characteristics remained similar in the two groups at the 5-year follow-up mark. No differences existed in the primary outcome of reported bothersome SUI symptoms (30.8% Scissors vs 26.8% Babcock, p = 0.559), proportion of participants with bothersome OAB, the median scores of three validated bladder questionnaires, or in rates and cumulative incidence of recurrent MUS surgery or surgical revision of mesh-related complications. Both the Scissor and Babcock tensioning techniques provided comparable outcomes at 5 years post-MUS surgery. The information from this study allows surgeons to better decide which technique to adopt in their practice, providing confidence in longer-term cure and safety.

No difference in patient-reported outcomes or range of motion between ultracongruent and posterior stabilized total knee arthroplasty: A randomized controlled trial.

Ultracongruent (UC) inserts were designed to overcome potential issues with posterior stabilized (PS) inserts, including bone resection, post-breakage, and patellar clunk syndrome. However, there remains a shortage of high-quality studies directly comparing this insert design to the established PS Total Knee Arthroplasty (TKA). This prospective randomized controlled trial (RCT) aimed to compare clinical outcomes, range of motion, and complications of UC and PS TKA. Ninety six patients with primary knee osteoarthritis were randomly assigned to either the PS or the UC group. There were no significant differences between the groups regarding age, body mass index, sex, or Osteoarthritis grade. The measured outcomes were Knee Injury and Osteoarthritis Outcome Score (KOOS) and Range of Motion (ROM), recorded preoperatively and at 3 and 6 months postoperative. Both the patient and interviewer were blinded to the allocation group. Eighty one patients were included in the analysis, with a mean follow-up of 1.3 years. Both groups exhibited a gradual improvement in KOOS. Still, no statistically significant differences were observed between the groups during the follow-up examinations at 3 or 6 months in KOOS or range of motion. No complication occurred in either group during the follow-up period. Both designs demonstrated comparable positive outcomes, reinforcing the viability of UC designs as an alternative to the well-established PS TKA. Level l, randomized controlled trial.

Patient-Reported and Economic Racial and Ethnic Disparities in Patients with Psoriatic Arthritis: Results from the National Health and Wellness Survey.

Psoriatic arthritis (PsA) is a chronic, autoimmune form of arthritis that is associated with a substantial humanistic and economic burden. Potential differences in patient-reported outcomes (PROs) and economic outcomes among groups of varying PsA severity and different races/ethnicities have not been well studied. This cross-sectional study assessed sociodemographic data, PROs, and economic outcomes for participants with PsA from the National Health and Wellness Survey (2018-2020). Multivariable analyses were used to assess the association of self-reported PsA severity and race/ethnicity with health-related quality of life (HRQoL), work productivity and activity impairment (WPAI), healthcare resource utilization (HCRU), and medical costs. This study included 1544 participants with PsA (1073 non-Hispanic white, 114 non-Hispanic Black, 223 Hispanic, and 134 Other). Self-reported moderate/severe PsA was associated with significantly worse HRQoL and WPAI, greater HCRU, and higher costs than self-reported mild PsA. Black participants reported more absenteeism (31.11% vs. 16.69%; P = 0.007) and activity impairment (54.27% vs. 47.96%; P = 0.047) than white participants, and fewer healthcare provider (5.93 vs. 7.42; P = 0.039) and rheumatologist visits (0.29 vs. 0.53; P = 0.028) over the past 6months. No differences in outcomes were observed between Hispanic and white participants. Race/ethnicity moderated the association of perceived PsA severity and PROs and HCRU, such that white participants with self-reported moderate/severe PsA had a higher likelihood of depression (P < 0.001), lower HRQoL (P < 0.001), and more emergency room visits (P = 0.001) than those with self-reported mild PsA. Race/ethnicity did not moderate the relationship of PROs, HCRU, and economic outcomes among Black or Hispanic participants. Participants with self-reported moderate/severe PsA reported a greater burden than those with self-reported mild PsA. Black participants had a greater humanistic burden than white participants but reported lower HCRU. Moderation results were driven by white participants, suggesting important differences in PROs, HCRU, and perception of PsA severity across race/ethnicity groups. Small sample sizes in Hispanic and non-Hispanic racial/ethnic groups limited ability to discern differences related to disease severity in these groups. Further research is needed to better understand the differential burden of PsA among individuals with varying perceptions of PsA severity across different racial/ethnic groups.

Can a New, Satellite Inpatient Hospital Maintain the Efficiency of an Ambulatory Surgery Center with No Difference in Patient-Reported Outcomes?: A Prospective Study

BackgroundPrevious research has found that anterior cruciate ligament (ACL) reconstructions performed at Ambulatory Surgery Centers (ASCs) are more time efficient. However, recent literature investigating this phenomenon within the pediatric population is limited and primarily retrospective. The goal of this study was to prospectively compare the operating room (OR) efficiency of pediatric ACL reconstructions performed across different surgical settings. MethodsAdolescent patients (12-18 years) undergoing ACL reconstruction by a single surgeon were prospectively enrolled from 2020-2024. Patients were cohorted based on the location of their surgery at one of three sites: 1) a traditional, tertiary-care academic hospital, 2) hospital-owned ASCs, or 3) a satellite inpatient hospital that was built and connected to an ASC in January 2022. Patient preoperative, surgical, and postoperative data was collected, and surgical efficiency was compared across surgical sites using a variety of metrics. Patient-reported outcomes (PROMs) were collected using the Pedi-FABS and Pedi-IKDC questionnaires. ResultsA total of 115 patients (56.5% female, mean age 15.4 +/- 1.7 years) met inclusion criteria and were enrolled. 31 patients (27.0%) had ACL reconstructions at the main inpatient hospital, 36 (31.3%) at hospital-owned ASCs, and 48 (41.7%) at the new satellite inpatient hospital. When controlling for concomitant procedures, regional anesthesia type, and staff, there was a significant difference in total OR in-room, anesthesia induction, surgery preparation, surgery duration, and dressing application/wake-up times among the three cohorts (p<0.001). Both the ASCs and the satellite inpatient hospital had shorter total OR in-room and surgery duration times than the main inpatient hospital (p<0.001). There were no differences in patient-reported outcomes among the three cohorts (p>0.05). ConclusionsAdolescent ACL reconstructions performed at either an ASC or a satellite inpatient hospital were more time efficient than those performed at a traditional, main inpatient hospital with no differences in PROMs. Institutions should consider implementing strategies used at ASCs, such as standardized surgical teams, at main hospitals to increase efficiency. Level of EvidenceII (Prospective Cohort Study)

An Opioid-Sparing Pain Protocol of Intravenous and Oral Ketorolac Reduces Opioid Consumption and Pain Levels After Arthroscopic Meniscus Surgery: A Prospective, Randomized Controlled Trial

The primary purpose was to compare ketorolac to oxycodone-acetaminophen with respect to pain and opioid consumption after arthroscopic meniscus surgery. The secondary purpose was to compare short-term functional outcomes between the 2 protocols. A power analysis demonstrated that 43 patients were required. In this randomized control trial, patients with meniscal pathology undergoing arthroscopic meniscus surgery were included. Group 1 received oxycodone-acetaminophen alone. Group 2 received 1 dose of intravenous ketorolac intraoperatively, oral ketorolac upon discharge, and "rescue" oxycodone-acetaminophen. Patients recorded the number of opioid tablets consumed and visual analog pain scale (VAS) scores 3 times per day for 5 days postoperatively. Opioids were converted to morphine milligram equivalents (MMEs). VAS, Lysholm Knee Scoring Scale, and Knee injury and Osteoarthritis Outcome Score were obtained. Forty-eight patients were randomized. There were 25 patients in the control group and 23 patients in the ketorolac group. The mean (SD) age was 47.9 (14.3) years. Fifty-two percent (n= 25) of the population were female. Three patients (6.3%) underwent meniscal repair. During the first 5 days postoperatively, the mean VAS score (β= -13.2, SE= 5.97, P= .029) and the MMEs consumed were significantly lower (β= -4.7, SE= 1.93, P= .015) per time point in the ketorolac group relative to the control group. The control group had better Lysholm Knee Scoring Scale (mean [SD] 80.6 [18.5] vs 65 [21.5], P= .016) and Knee injury and Osteoarthritis Outcome Score (mean [SD], 74.1 [16.7] vs 61.9 [18.6], P= .029) scores at 6 weeks. There were no significant differences in the rates of side effects. An opioid-sparing pain protocol of intravenous and oral ketorolac is associated with significant reductions in VAS scores and MME consumption in the first 5 days after arthroscopic meniscus surgery. There were significant differences in patient-reported outcomes at final follow-up, favoring the control group. There were no significant differences in adverse reactions and side effects. Therapeutic Level II, prospective randomized controlled trial.

PRESERVATION OF THE LATERAL CIRCUMFLEX ARTERY IN DIRECT ANTERIOR APPROACH TOTAL HIP ARTHROPLASTY: EFFECT ON MUSCLE STATUS AND CLINICAL OUTCOMES

The direct anterior approach (DAA) is a popular minimally invasive approach for total hip arthroplasty (THA). It usually involves ligation of the lateral femoral circumflex artery's ascending branch (a-LFCA), which contributes to the perfusion of the tensor fasciae latae (TFL) muscle. Periarticular muscle status and clinical outcome were assessed after DAA-THA after a-LFCA preservation versus ligation.We evaluated surgical records of 161 patients undergoing DAA-THA with tentative preservation of the a-LFCA by the senior author between May and November 2021. Among 92 eligible patients, 33 (35 hips) featured successful preservation, of which 20 (22 hips, 13 female) participated in the study. From 59 patients with ligated a-LFCA, 26 (27 hips, 15 female) were enrolled, constituting the control group. MRI and clinical examinations were performed at 17–26 months to analyze volume and fatty infiltration of the TFL, gluteus medius and gluteus minimus muscles relative to the contralateral non-THA hip (15 preserved, 18 ligated). Clinical and radiographic data was retrospectively extracted from patient files. Patient-reported outcomes (PROMs) were added from the THA registry.There was a relative difference in TFL muscle volume of -6.27 cm3 (−9.89%, p=0.018) after a-LFCA preservation versus -8.6 cm3 (=11.62%, p=0.002) after ligation, without group differences (p&gt;0.340). a-LFCA preservation showed lower relative TFL fatty infiltration (p=0.10). Gluteal muscle status was similar between sides and groups. Coxa valga morphology was more frequent in a-LFCA preservation (83%) than ligation (17%). Clinical outcomes showed high patient satisfaction in both groups, without difference in PROMs, but less anterolateral soft-tissue swelling after a-LFCA preservation (p&lt;0.001).Despite excellent clinical results in both groups, preservation of the a-LFCA was associated with less TFL fatty infiltration and soft tissue swelling. Provided there is no compromise of intraoperative access we recommend a-LFCA preservation for DAA-THA.

SURGICAL APPROACH IMPACTS PATIENT-REPORTED SYMPTOMS FOLLOWING ARTHROPLASTY FOR FEMORAL NECK FRACTURE

We aimed to examine outcomes between displaced femoral neck fracture (FNF) patients managed with total hip arthroplasty (THA) or hemi-arthroplasty (HA) via the anterolateral vs. posterior approach.We used data from the HEALTH trial (1,441 patients aged ≥50 with displaced FNFs randomized to THA vs. HA). We calculated each patient's propensity to undergo arthroplasty via the posterior approach, and matched them to 1 control (anterolateral approach) based on age (±5 years), and propensity score. We used Chi-Square/Fisher-Exact tests to compare dichotomous outcomes, and repeated measures ANOVA to examine differences in patient-reported outcomes (via the WOMAC subscores) from baseline to one-year postoperative. We used logistic regression to identify independent predictors of reoperation for instability in the posterior group.We identified 1,306 patients for this sub-analysis, 876 (67.1%) who received arthroplasty via an anterolateral approach, and 430 (32.9%) a posterior approach. The unadjusted rate of reoperation was significantly higher in the posterior group (10.7% vs. 7.1%).Following propensity score matching, we retained 790 patients (395 per group), with no between-group differences in patient, fracture, or implant characteristics. The matched cohort had a higher rate of comorbidities, and were less likely to be employed vs. the unmatched cohort. The rate of treatment for dislocation remained higher in the posterior group (6.1% vs. 2.0%) following matching.Repeated measures ANOVA revealed significantly better WOMAC pain, stiffness, function, and total scores in the posterior group. Between-group differences at 12-months were: pain - 0.59 (0.03–1.15); stiffness - 0.62 (0.35–0.87); function - 2.99 (0.12–5.86); total - 3.90 (0.24–7.56). We identified THA (vs. HA, odds ratio 2.05 [1.05–4.01]) as the only independent predictor of treatment for dislocation in the posterior group.Our analyses revealed that compromised patients with displaced FNFs who undergo arthroplasty via the posterior approach may report better symptoms at one-year vs. the anterolateral approach, despite a higher odds of reoperation for instability.

Sex differences in patient-reported outcomes and the association with clinical factors in axial spondyloarthritis patients treated with tumour necrosis factor inhibitors.

To investigate sex differences in patient-reported outcome measures (PROMs) among axSpA patients initiating their first TNFi and identify factors contributing to these disparities over the follow-up. Data were included from 15 EuroSpA registries and consisted of axSpA patients initiating their first TNFi, with ≥2 measurements for each analysed PROM (BASDAI and BASFI, scale 0-100) taken at any time point. Linear mixed models were employed to analyse sex differences in PROMs over 24 months and to evaluate how baseline characteristics were related to the observed sex differences. We analysed 13 102 (38% women) in the BASDAI analyses and 10 623 (38% women) in the BASFI analyses. At follow-up, mean sex differences in BASDAI increased from 4.3 units at baseline (95% CI, 3.5-5.1)-8.0 (7.2-8.8) at 6 months, and in BASFI from 2.2 (1.4-3.1)-4.6 (3.6-5.5), with consistently worse scores in women. Baseline characteristics could not substantially account for the observed sex differences over time; however, the magnitude of the sex differences was reduced by HLA-B27 positivity, longer disease duration, and increased CRP levels, but increased by TNFi initiation in later years and peripheral arthritis. In axSpA patients initiating their first TNFi, baseline sex differences in BASDAI and BASFI increased two-fold after 6 months of treatment and persisted thereafter, with worse scores in women. Several baseline characteristics moderated the sex differences, though none could fully account for them. These findings improve our understanding of sex differences and underscore their importance in axSpA.

The COVID-19 pandemic experience for patients with central nervous system tumors: Differences in patient-reported outcomes and practice recommendations

The COVID-19 pandemic experience for patients with central nervous system tumors: Differences in patient-reported outcomes and practice recommendations

Poster 127: Repairs of Isolated Supraspinatus Tears: Single vs. Double Row Repairs Effect on Patient-Reported Outcomes Over a 2-Year Episode of Care

Objectives: Rotator cuff tears are the most common cause of shoulder disability, most commonly affecting the middle-aged population. Treatment for rotator cuff tears has changed dramatically over the past few decades, with overall volume of rotator cuff repairs (RCRs) increasing by approximately 1.6% each year. Simultaneously, there has been a shift from open, inpatient RCR to arthroscopic, outpatient procedures. Currently, well over 75% of patients undergo arthroscopic repair. The two most common techniques for rotator cuff fixation include single- or double-row fixation. Cadaveric and biomechanical studies demonstrate more complete reduction of the rotator cuff to its original footprint with double row repair, with a subsequent increase in anatomic restoration and biomechanical advantage. Many studies regarding clinical and functional outcomes, however, have not consistently demonstrated statistically significant differences between the two. The purpose of this study is to determine differences in patient-reported outcomes (PROs) after single- and double-row rotator cuff repairs at one and two years postoperatively. We hypothesize that single-row RCR will have noninferior clinical and patient-reported outcomes when compared to the double-row RCR cohort over the 2-year episode of care. Primary outcomes include baseline, 1-year and 2-year postoperative Single Assessment Numeric Evaluation (SANE) scores. Methods: All patients within a single health system that underwent primary rotator cuff repair between 2016 and 2022 were eligible for inclusion in this study. Exclusion criteria included incomplete baseline PROs, involvement of infraspinatus, subscapularis or teres minor tendons, revision surgeries, and concomitant fractures of the shoulder. Demographic information including age, sex, BMI, ASA score, injury characteristics and medical comorbidities were obtained through review of the patients’ electronic medical record. Surgical characteristics and technique were obtained from operative notes. PROs were collected prospectively and stored in a HIPAA-compliant electronic database until retrospective review for this study. Primary outcomes of interest include SANE score at baseline, 1-year and 2-years postoperatively. Secondary outcomes of interest included American Shoulder and Elbow Surgeons (ASES) scores, Patient-Reported Outcomes Measurement Information System (PROMIS) global 10 health questionnaire scores, rates of symptomatic retear and reoperation. Statistical analysis included descriptive analyses, paired t-tests, chi-squared test of independence and one-way ANOVA as appropriate. Statistical significance was defined as an alpha value of p ≤ 0.05. Results: A total of 237 patients met criteria for inclusion in this study, the majority of which were female (122, 51.5%). The average BMI was 30.0 ± 5.6, and the average age of the study participants was 59.0 ± 9.4 years. The majority of patients underwent double-row RCR (134, 56.5%). There were no significant differences in age, BMI, ASA score, gender, or smoking status between the two groups (Table 1). There was a higher observed frequency of diabetes mellitus than expected in the double-row cohort, however this did not reach statistical significance (p = 0.066). There was no significant difference in symptomatic retear, revision RCR, and other reoperation rates between the two cohorts (Table 2). The cohort that received double-row repair had a higher observed frequency of full-thickness tears than expected (p &lt;0.001), however there was no significant difference in the observed frequencies of chronic and acute tears between the two cohorts. Baseline ASES scores did not differ significantly between the two cohorts (p = 0.505). Both cohorts saw statistically significant increase in ASES scores from baseline to 1-year (Figure 1). The difference between 1-year and 2-year ASES scores was less than a quarter of the improvement seen in the first year postoperatively, however, was still statistically significant in the double-row cohort and neared statistical significance in the single-row cohort (p = 0.048 and p = 0.075, respectively). While both cohorts saw significant improvement in ASES scores over the 2-year period, there was no significant difference in score change between the two cohorts. The baseline SANE scores were 40.7 ± 20.6 and 43.2 ± 21.4 for the double and single-row cohorts respectively. Each cohort saw statistically significant increases in SANE scores at 1 year postoperatively and continued to see significant increase between 1- and 2-years postoperatively (Figure 1). There was no statistically significant difference between the two cohorts regarding 1- and 2-year change in SANE scores. Conclusions: Over a 2-year period of care after RCR, patients saw significant improvement in SANE and ASES scores, with the majority occurring in the first year postoperatively. There were no statistically significant differences in patient-reported outcomes between patients that underwent double- and single-row repairs. Single- and double-row RCRs perform comparably over a 2-year episode of care, with excellent clinical and patient-reported outcomes. [Figure: see text]

Poster 344: The New "Terrible Triad": Anterior Cruciate Ligament Reconstruction With Concurrent Meniscal Lateral Root and Medial Ramp Repairs

Objectives: The purpose of this paper was to compare patient reported outcomes (PROMs) between isolated anterior cruciate ligament (ACLR) and ACLR with concomitant medial meniscus ramp and lateral meniscus root repairs and compare PROMs between different medial meniscus ramp and lateral meniscus root repair techniques. Methods: All patients with isolated (ISO) ACL reconstruction or ACL reconstruction with concomitant medial meniscus ramp and lateral meniscus root repairs with a minimum 2 years of follow-up were retrospectively evaluated. Institutional review board approval was obtained for this study. A final total of 42 ISO-ACL patients were matched based upon age, sex, and body mass index to 40 in the “terrible triad” (TT) cohorts. Outcome measures were obtained from 32 patients in the ISO cohort, and 38 patients in the TT cohort. The PROMs used for this study include the International Knee Documentation Committee (IKDC) Subjective Knee, Cincinnati, Tegner, Lysholm, Veterans RAND 12-Item Health Survey (VR-12), and Knee Injury and Osteoarthritis Outcomes Score (KOOS) questionnaire forms. T tests and chi-square goodness of fit tests were used to compare the above PROMs both pre- and postoperatively within each cohort, and between cohorts and rates of revision or reoperation. Results: The preoperative and postoperative PROMs between patients in the isolated cohort and the triad cohort demonstrated no significant differences, except for the Physical category of the VR-12, in which the triad cohort had significantly higher results (p = 0.04) (Figure 1). Both the isolated cohort and the triad cohort reported significant differences between pre- and postoperative PROMs within their own cohorts. When comparing methods of surgery, including all-inside vs. inside-out for the medial meniscus repairs and tunnel versus no-tunnel for the lateral meniscus root repairs, no significant differences were found between postoperative PROMs. Additionally, no significant difference was found in revision or reoperative rates between the triad and isolated cohorts (p = 0.374) (Figure 2), the all-inside versus inside-out medial meniscus cohorts (p = 0.267), or the tunnel vs. no-tunnel lateral meniscus cohorts (p = 0.781). Conclusions: There was no significant difference in PROMs between isolated ACLR versus ACLR with concomitant medial meniscus ramp and lateral meniscus root repairs. While the complexity of the TT ACLR patients was more involved, PROMs and healing rates were similar and performing concurrent medial ramp and lateral root repairs at the time of ACLR should be considered.

Impact of Rectal Spacer on Toxicity Reduction in Men Treated With Proton Versus Photon Therapy

PurposeRectal toxicity after prostate cancer (PCa) radiation therapy (RT) may be greater with protons compared with photon intensity-modulated RT, perhaps due to lateral penumbra and end-of-range uncertainty. Rectal spacers (RSs) have been shown to mitigate RT-associated acute/late rectal toxicity in men treated with photons. The relative benefit of RS in men treated with protons versus photons is unknown. We hypothesize that RS will confer greater bowel toxicity benefits in PCa treated with protons versus photons. Materials and MethodsWe conducted a single institution, retrospective review of men receiving photon intensity-modulated RT or pencil-beam scanning proton RT for localized PCa. Four cohorts were compared: photon with or without RS, and proton with or without RS. Acute (<3 months), late (≥3 months), and most recent toxicity were compared among the 4 cohorts. The cumulative incidence of physician-reported grade 1 to 2 gastrointestinal (GI) toxicity (common terminology criteria for adverse events V5.0) was compared using χ2 or Fisher exact test. Patient-reported toxicity was evaluated using the International Prostate Expanded Prostate Composite Index-Clinical Practice and compared using linear mixed modeling. ResultsIn total, 164 patients were eligible for analysis: 38 photons without RS, 50 photons with RS, 26 protons without RS, and 50 protons with RS. The median follow-up was 17.6 months. In proton patients, acute (6.12% vs 30.77%, P = .009) and most recent (4.26% vs 26.09%, P = .01) G1-2 GI toxicity was lower with versus without RS. In photon patients, there were no significant differences in toxicity with versus without RS. No significant differences in patient-reported outcomes were observed with versus without RS in photon or proton groups. ConclusionThe rectal spacer was associated with lower G1-2 acute and most recent GI toxicity in men treated with protons; this difference was not observed in men treated with photons. While this study is limited by sample size, a relatively greater benefit of RS with proton versus photon therapy was observed.

A COMPARISON OF FUNCTIONAL OUTCOME SCORES FOR PRIMARY AND REVISION ANKLE ARTHROPLASTIES

BackgroundPatients who undergo either primary or revision total ankle replacement (TAR) expect improvements in pain, function and quality of life. The goal of this study was to measure the functional outcome improvements and the difference in patient-reported outcomes in patients undergoing primary total ankle replacements compared to revision TAR.MethodsA single-center prospective cohort study was undertaken between 2016 and 2022. All patients were followed up for a minimum of 6 months. Patients undertook the Manchester Oxford Foot Questionnaire (MoxFQ) and EQ-5D health quality questionnaires pre-operatively, at 6 months and yearly for life. The Mann Whitney test was undertaken for statistical analysis.ResultsA total of 165 primary and 71 revision ankle replacements were performed between 2016 and 2022. The mean age was 71 years for primary replacements and 69 years for revisions. The INFINITY was utilized in the majority of primary total ankle replacements. Revision replacements were either the INBONE II or INVISION and they were most often revising the MOBILITY implant. The main indication for revision was aseptic loosening (83%). Other causes included infection, malalignment and insert wear. The overall MoxFQ improved by a mean of 46.5 for primaries and 40.2 for revisions. The EQ-5D score also showed overall improvements with the mean difference in mobility increasing by 1.6.ConclusionBoth primary and revision ankle replacements result in improved functional scores at 6 months, 1 year and 2 years. In this cohort with the implants used, both primary and revision ankle replacements demonstrate similar improvements in functional scores.

Complications after gender-affirming chest masculinization surgery do not impact patient satisfaction

Chest masculinization surgery is an increasingly common procedure and has offered significant benefits to the gender-diverse community. Although major complications are an infrequent occurrence in chest masculinization surgery, they may still impact surgical success. While the long-term success of chest masculinization surgery has been examined through patient-reported outcome measures, there is no study that has assessed the association between complications and patient-reported outcomes. In this study, patients who underwent double incision or periareolar mastectomies for chest masculinization by a single surgeon were surveyed. Demographic, operative, and postoperative variables were obtained from medical records. The BODY-Q and SCAR-Q modules (Q-Portfolio.org) were used to assess postoperative patient-reported outcomes. There were 151 survey responders (43% response rate), 132 without complications and 19 with complications. No significant differences in patient-reported outcomes were noted when comparing the groups with and without complications. While some providers may be reluctant to offer chest masculinization to patients they deem high risk for complications, patients and providers should be assured that complications do not significantly impact patient satisfaction. LAY SUMMARY: Gender-affirming chest masculinization surgery is increasingly common. We investigated the impact of complications on patient-reported outcomes in chest masculinization. Patients and providers should be assured that complications do not significantly impact patient satisfaction.

Minimal clinically important differences in patient-reported outcomes after coronary artery bypass surgery in the arterial revascularization trial.

This article identifies minimal clinically important differences (MCIDs) in quality of life (QoL) measures among patients who had coronary artery bypass grafting (CABG) and were enrolled in the arterial revascularization trial (ART). The European Quality of Life-5 Dimensions (EQ-5D) and the Short Form Health Survey 36-Item (SF-36) physical component (PC) and mental component (MC) scores were recorded at baseline, 5 years and 10 years in ART. The MCIDs were calculated as changes in QoL scores anchored to 1-class improvement in the New York Heart Association functional class and Canadian Cardiovascular Society scale at 5 years. Cox proportional hazard models were used to evaluate associations between MCIDs and mortality. Patient cohorts were examined for the SF-36 PC (N = 2671), SF-36 MC (N = 2815) and EQ-5D (N = 2943) measures, respectively. All QoL scores significantly improved after CABG compared to baseline. When anchored to the New York Heart Association, the MCID at 5 years was 17 (95% confidence interval: 17-20) for SF-36 PC, 14 (14-17) for the SF-36 MC and 0.12 (0.12-0.15) for EQ-5D. Using the Canadian Cardiovascular Society scale as an anchor, the MCID at 5 years was 15 (15-17) for the SF-36 PC, 12 (13-15) for the SF-36 MC and 0.12 (0.11-0.14) for the EQ-5D. The MCIDs for SF-36 PC and EQ-5D at 5 years were associated with a lower risk of mortality at the 10-year follow-up point after surgery. MCIDs for CABG patients have been identified. These thresholds may have direct clinical applications in monitoring patients during follow-up and in designing new trials that include QoL as a primary study outcome. ISRCTN46552265.

Hydrogen Peroxide May Reduce the Risk for Revision Surgery and Infection in Primary Shoulder Arthroplasty: Two-year Follow-up From a Prospective, Blinded, Controlled Trial.

The purpose of this study was to determine whether the addition of hydrogen peroxide to the preoperative skin preparation for primary total shoulder arthroplasty is associated with a difference in patient-reported outcomes, risk for postoperative infection, and risk for revision surgery at a minimum of 2-year follow-up. This was a prospective, blinded, and controlled trial, which included a consecutive series of patients undergoing primary shoulder arthroplasty. The control group underwent standard sterile skin preparation using ethyl alcohol and ChloraPrep applicators, and the peroxide group had the same preparation with the addition of hydrogen peroxide between the alcohol and ChloraPrep applications. We then compared patient-reported outcome scores (American Shoulder and Elbow Surgeons Shoulder Score [ASES], simple shoulder test [SST], visual analog scale [VAS]), infections, and revision surgeries between the two groups at 2-year follow-up. Of the 61 patients included in the original study, 52 of 58 (85%) living patients agreed to participate in this study. No preoperative differences were observed between groups. No difference was observed in ASES, SST, or VAS scores at 2 years. More revision surgeries were done in the control group (7 versus 2, P = 0.268) and Cutibacterium acnes infections (2 versus 0, P = 0.168). The addition of hydrogen peroxide to the preoperative skin preparation before primary shoulder arthroplasty is safe, and additional research is warranted to investigate whether it may decrease the risk for revision surgery and postoperative C acnes infection. III.

More than 3 mm of preoperative medial meniscal extrusion is identified as a key risk factor for varus progression in limb alignment after arthroscopic repair of medial meniscus posterior root tear.

To investigate the risk factors for varus progression after arthroscopic medial meniscal posterior root tear (MMPRT) repair and to compare the clinical outcomes between two groups: one with more varus progression and the other with less varus progression. Patients who underwent isolated arthroscopic repair of MMPRT between 2015 and 2020 were enroled, and 2-year follow-up data were collected. Participants were categorized into two groups based on preoperative values of the weight-bearing line (WBL) ratio: group A with <5.9% increase and group B with ≥5.9% increase. Various factors, including demographic features and radiological findings, were analysed and compared between the two groups. Intra-meniscal signal intensity, meniscal healing, medial meniscal extrusion (MME), and articular cartilage grade were assessed preoperatively and 1-year postoperatively using coronal magnetic resonance imaging. The final cohort consisted of 34 patients in group A and 46 in group B, with a mean age of 55.8 ± 11.2 and 59.8 ± 6.6 years, respectively. Preoperative WBL ratio and cartilage lesions in the medial compartment did not differ between the groups. Preoperative MME were significantly lower in group A than those in group B (2.6 ± 0.6 mm in group A and 3.5 ± 0.7 mm in group B, p < 0.05). Patient-reported outcomes at the 2-year follow-up did not differ between the two groups (n. s.). In a logistic analysis, the odds ratio of MME was 2.1 (p < 0.05), and the cutoff value of MME was 3.02 mm. Preoperative MME is a risk factor for varus progression. However, no differences in patient-reported outcomes were observed at 2-year follow-up, even in the group with greater varus progression. Level IV.

What Is the Patient-reported Outcome and Complication Incidence After Operative Versus Nonoperative Treatment of Minimally Displaced Tibial Plateau Fractures?

Much controversy remains about whether minimally displaced tibial plateau fractures should be treated operatively or nonoperatively. It is generally accepted that gaps and stepoffs up to 2 mm can be tolerated, but this assumption is based on older studies using plain radiographs instead of CT to assess the degree of initial fracture displacement. Knowledge regarding the relationship between the degree of fracture displacement and expected functional outcome is crucial for patient counseling and shared decision-making, specifically in terms of whether to perform surgery. (1) Is operative treatment associated with improved patient-reported outcomes compared with nonoperative treatment in minimally displaced tibial plateau fractures (fractures with up to 4 mm of displacement)? (2) What is the difference in the risk of complications after operative versus nonoperative treatment in minimally displaced tibial plateau fractures? A multicenter, cross-sectional study was performed in patients treated for tibial plateau fractures between 2003 and 2019 at six hospitals. Between January 2003 and December 2019, a total of 2241 patients were treated for tibial plateau fractures at six different trauma centers. During that time, the general indication for open reduction and internal fixation (ORIF) was intra-articular displacement of > 2 mm. Patients treated with ORIF and those treated nonoperatively were potentially eligible; 0.2% (4) were excluded because they were treated with amputation because of severe soft tissue damage, whereas 4% (89) were excluded because of coexisting conditions that complicated outcome measurement including Parkinson disease, cerebrovascular accident, or paralysis (conditions causing an inability to walk). A further 2.7% (60) were excluded because their address was unknown, and 1.4% (31) were excluded because they spoke a language other than Dutch. Based on that, 1328 patients were potentially eligible for analysis in the operative group and 729 were potentially eligible in the nonoperative group. At least 1 year after injury, all patients were approached and asked to complete the Knee injury and Osteoarthritis Outcome Scale (KOOS) questionnaire. A total of 813 operatively treated patients (response percentage: 61%) and 345 nonoperatively treated patients (response percentage: 47%) responded to the questionnaire. Patient characteristics including age, gender, BMI, smoking, and diabetes were retrieved from electronic patient records, and imaging data were shared with the initiating center. Displacement (gap and stepoff) was measured for all participating patients, and all patients with minimally displaced fractures (gap or stepoff ≤ 4 mm) were included, leaving 195 and 300 in the operative and nonoperative groups, respectively, for analysis here. Multivariate linear regression was performed to assess the association of treatment choice (nonoperative or operative) with patient-reported outcomes in minimally displaced fractures. In the multivariate analysis, we accounted for nine potential confounders (age, gender, BMI, smoking, diabetes, gap, stepoff, AO/OTA classification, and number of involved segments). In addition, differences in complications after operative and nonoperative treatment were assessed. The minimum clinically important differences for the five subscales of the KOOS are 11 for symptoms, 17 for pain, 18 for activities of daily living, 13 for sports, and 16 for quality of life. After controlling for potentially confounding variables such as age, gender, BMI, and AO/OTA classification, we found that operative treatment was not associated with an improvement in patient-reported outcomes. Operative treatment resulted in poorer KOOS in terms of pain (-4.7 points; p = 0.03), sports (-7.6 points; p = 0.04), and quality of life (-7.8 points; p = 0.01) compared with nonoperative treatment, but those differences were small enough that they were likely not clinically important. Patients treated operatively had more complications (4% [7 of 195] versus 0% [0 of 300]; p = 0.01) and reoperations (39% [76 of 195] versus 6% [18 of 300]; p < 0.001) than patients treated nonoperatively. After operative treatment, most reoperations (36% [70 of 195]) consisted of elective removal of osteosynthesis material. No differences in patient-reported outcomes were observed at midterm follow-up between patients treated surgically and those treated nonsurgically for tibial plateau fractures with displacement up to 4 mm. Therefore, nonoperative treatment should be the preferred treatment option in minimally displaced fractures. Patients who opt for nonoperative treatment should be told that complications are rare, and only 6% of patients might undergo surgery by midterm follow-up. Patients who opt for surgery of a minimally displaced tibial plateau fracture should be told that complications may occur in up to 4% of patients, and 39% of patients may undergo a secondary intervention (most of which are elective implant removal). Level III, therapeutic study.

Nerve Block Guided by Anatomic Landmarks Only Reduces Pain in Botulinum Toxin Type A Treatment for Glabellar and Forehead Wrinkles.

Botulinum toxin type A is widely used to treat glabellar and forehead wrinkles, but the pain caused by multiple injections often deters patients from receiving long-term treatment. Despite several methods used to alleviate this pain, consistency and effectiveness remain a challenge. Therefore, this study aimed to evaluate the effectiveness and safety of nerve block guided by anatomic landmarks only in reducing pain associated with botulinum toxin type A injections. Between 2018 and 2022, the study enrolled 90 patients divided into 3 groups: the nerve block group (n = 30), the lidocaine cream group (n = 30), and the control group (n = 30). In the nerve block group, a landmarks-based technique was used to perform the nerve block. The study collected general information and comorbidities, and recorded pain at each point and time spent on preparation and treatment for each patient's forehead and glabellar area on each side. Patient-reported outcomes and complications were followed up at 2, 4, and 12 weeks after the injections. The nerve block group had significantly lower total pain scores in all regions compared to the lidocaine cream and control groups (P < 0.01). There were no significant differences in patient-reported outcomes between the groups at any follow-up point. Additionally, the complication rates related to injection were low and comparable among the 3 groups. Nerve block guided by anatomic landmarks only is a safe, effective, and consistent approach to reduce pain during botulinum toxin type A treatment for glabellar and forehead lines. This technique may offer advantages over other methods used to alleviate the pain associated with these injections.

Evaluation of 30-day outcomes for open ventral hernia repair using self-gripping versus nonself-gripping mesh.

The use of mesh is standard of care for large ventral hernias repaired on an elective basis. The most used type of mesh includes synthetic polypropylene mesh; however, there has been an increase in the usage of a new polyester self-gripping mesh, and there are limited data regarding its efficacy for ventral hernia. The purpose of the study is to determine whether there is a difference in surgical site occurrence (SSO), surgical site infection (SSI), surgical site occurrence requiring procedural intervention (SSOPI), and recurrence at 30 days after ventral hernia repair (VHR) using self-gripping (SGM) versus non-self-gripping mesh (NSGM). We performed a retrospective study from January 2014 to April 2022 using the Abdominal Core Health Quality Collaborative (ACHQC). We collected data on patients over 18 years of age who underwent elective open VHR using SGM or NSGM and whom had 30-day follow-up. Propensity matching was utilized to control for variables including hernia width, body mass index, age, ASA, and mesh location. Data were analyzed to identify differences in SSO, SSI, SSOPI, and recurrence at 30 days. 9038 patients were identified. After propensity matching, 1766 patients were included in the study population. Patients with SGM had similar demographic and clinical characteristics compared to NSGM. The mean hernia width to mesh width ratio was 8cm:18cm with NSGM and 7cm:15cm with SGM (p = 0.63). There was no difference in 30-day rates of recurrence, SSI or SSO. The rate of SSOPI was also found to be 5.4% in the nonself-gripping group compared to 3.1% in the self-gripping mesh group (p < .005). There was no difference in patient-reported outcomes at 30 days. In patients undergoing ventral hernia repair with mesh, self-gripping mesh is a safe type of mesh to use. Use of self-gripping mesh may be associated with lower rates of SSOPI when compared to nonself-gripping mesh.