Postoperative Medical Complications Research Articles

Achondroplasia Status and Adverse Short-Term Postoperative Outcomes in Elective Spinal Decompression Surgery: A Propensity Score-Matched Case-Control Study.

Achondroplasia is the most common form of skeletal dysplasia, affecting approximately 1 in 25,000 individuals in the US. Previous research suggests that achondroplasia patients undergoing spine surgery have worse postoperative outcomes. Most of these findings are based on small, single-center retrospective studies and describe the impact of achondroplasia status on only one or two outcomes. We sought to assess the association between achondroplasia and a comprehensive battery of postoperative care outcomes in a national cohort. The Merative™ Marketscan® Commercial Database and the accompanying Medicare Supplement were queried for adult patients diagnosed with achondroplasia who underwent elective thoracic/thoracolumbar or lumbar decompression +/- fusion surgery between 2006 and 2023. Propensity score matching was used to identify an equal number of age and sex-matched controls without achondroplasia. Outcomes of interest were length of hospital stay, non-home discharge disposition, 90-day readmission and postoperative medical or surgical complications. Bivariate analyses were conducted to examine the distribution of baseline characteristics based on achondroplasia status. Multivariate regression was employed to assess the association between achondroplasia status and short-term postoperative outcomes. Overall, 111 achondroplasia cases and an equal number of age- and sex-matched controls were included. Compared to controls, those with achondroplasia were more likely to have a longer length of hospital stay (B-coefficient=3.34, 95% confidence interval [95% CI]=1.00-4.70), non-home discharge (odds ratio [OR]=20.51, [5.78-72.73]) and a higher complication rate (OR = 3.63, [1.49-8.87]). The association between achondroplasia status and 90-day readmission did not reach statistical significance (p=0.48). Patients with achondroplasia undergoing spinal surgery experience worse overall short-term postoperative outcomes compared to their age- and sex-matched counterparts. Patient-specific factors may contribute to the higher complication rates observed. While the presence of achondroplasia is unchangeable, surgeons should be prepared for increased risks in their management plans. These findings highlight the need for tailored preoperative assessments and enhanced postoperative strategies to improve outcomes in this vulnerable population.

Pre-operative Emergency Department Usage Is a Sentinel Marker of Worsened Posterior Lumbar Interbody Fusion Outcome.

Utilization of the emergency department (ED) is associated with medical and social comorbidities. These factors may also be associated with medical complications after complex surgeries. This study investigated how pre-operative ED use increases risk of posterior lumbar interbody fusion (PLIF) complications. We identified adult PLIF patients between 2016-2019 in the PearlDiver Claims Database. Clinical variables including Pre-operative ED use within 180 days were collected using International Classification of Disease (ICD-10) codes. Risk difference was calculated, and multivariable regression was performed. This study included 13,010 (21.1%) patients who went to the ED before surgery and 48,065 (78.9%) who did not. Having a pre-operative ED visit significantly increased risk of a post-operative ED visit by 28.7 percentage points, 90-day readmission by 3.8 percentage points, and 30-day major-medical complications by 3.4 percentage points. Risk of these outcomes increased in a dose-dependent fashion. Compared to patients with zero pre-operative ED visits, patients who had six or more pre-operative ED visits had an 82.0 percentage point increase in risk for a post-operative ED visit, a 46.5 percentage point increase for six or more ED visits, a 6.1 percentage point increase for major medical complications, and 10.6% increase for readmission. Patients with any pre-operative ED visit had an increased risk for post-operative ED use, readmission, and medical complications. The risk difference increased with each additional pre-operative visit. Patient counseling and protocols that reduce preventable ED visit in the pre-operative period may reduce a patient's risk for costly post-operative complications.

GLP-1 Agonist Use Increases the Incidence of Adhesive Capsulitis and Odds of Requiring Operative Management in Type 2 Diabetes Patients: A Matched Propensity Score Analysis.

The incidence of adhesive capsulitis (AC) is higher in patients with diabetes mellitus. While AC is usually treated non-operatively, diabetic patients are more likely to require more extensive treatments such as manipulation under anesthesia (MUA) or arthroscopic capsular release. Despite the recent surge in popularity of GLP-1 agonists ("GLP-1s") for the treatment of type 2 diabetes (T2DM), there is a lack of literature describing the effect of GLP-1 use on the incidence and management of AC in patients with T2DM. We aimed to compare T2DM patients with and without GLP-1 use, and determine differences in rates of AC, rates of operative AC management, and rates of 90-day postoperative complications among operatively managed AC patients. A retrospective cohort analysis of the PearlDiver database from 2010-2022 was performed to identify T2DM patients with AC. Exclusion criteria included patients <18 years old, type 1 diabetes, <2-year follow-up, and medical conditions that were a contraindication for GLP-1 use. Four cohorts were identified: 1) T2DM taking GLP-1s, 2) T2DM not taking GLP-1s, 3) T2DM with AC taking GLP-1s, and 4) T2DM with AC not taking GLP-1s. The primary outcome was the proportion of T2DM patients who developed AC. Secondary outcomes included rates of operative management and 90-day postoperative medical complications. A 1:1 propensity score match was performed, controlling for age, gender, Charlson Comorbidity Index, obesity, tobacco use, hypothyroidism, metformin use, insulin use, and the presence of complicated diabetes. Chi-square and Multivariable Linear Regression analyses were performed. 100,000 T2DM patients taking GLP-1s, and 100,000 T2DM patients not taking GLP-1s were randomly sampled. After matching, GLP-1 patients were more likely to develop AC (odds ratio [OR]=1.28, p<0.001). 253,717 T2DM patients with AC were then identified, of which, 46,156 (18.2%) were taking GLP-1s. After matching, GLP-1 users had higher odds of requiring operative management for AC compared to non-GLP-1 users (OR=1.18, p<0.001). The odds of undergoing MUA were significantly higher among GLP-1 users (OR=1.20, p<0.001), however, there was no difference in the odds of undergoing capsular release (OR=0.68, p=0.29). Among a national cohort of T2DM patients, patients taking GLP-1 agonists had higher odds of developing AC and requiring operative management for AC when compared to those not taking GLP-1s. These results can be useful when counseling T2DM patients who develop AC while taking GLP-1s to better inform these patients of the increased chance of requiring more extensive treatment.

Exploring the Impact of Preoperative Laboratory Values on Short-Term Outcomes in Complex Carpal Tunnel Decompression Surgery.

Background: The present study analyzes the effects of preoperative serum albumin, hematocrit, and creatinine on postoperative outcomes in patients undergoing carpal tunnel decompression surgery. Methods: The American College of Surgeons National Quality Improvement Program (NSQIP) database was queried from 2011 to 2020. Albumin, hematocrit, and creatinine were collected for each patient, alongside covariates. Outcomes included 30-day medical complications, 30-day wound complications, return to the operating room, nonhome discharge, and extended postoperative length of stay. Bivariate t-tests and multivariate logistic regressions were conducted. For any outcome-laboratory value pairs with significance on regression, area under the receiver operating characteristic curves (AUC) were constructed. Results: A total of 1440 patients with albumin, 3138 patients with hematocrit, and 3159 patients with creatinine levels were identified. Increased serum albumin was associated with lower odds of medical complications (aOR: 0.479, p=0.035). An overall cohort cutoff of ≤ 3.5 g/dL (AUC: 0.79, p < 0.001) was predictive of medical complications. On multivariate logistic regression, increased hematocrit reduced the odds of medical complications (aOR: 0.889, p < 0.001). Predictive hematocrit cutoffs of ≤ 39.7% (AUC: 0.77, p < 0.001) and ≤ 36.6% (AUC: 0.74, p < 0.001) were identified for medical complications amongst male and female patients, respectively. Similarly, increased serum creatinine was associated with greater odds of medical complications (aOR: 1.684, p=0.006). Creatinine cutoffs of ≥ 1.2 mg/dL (AUC: 0.58, p=0.033) and ≥ 1.0 mg/dL (AUC: 0.59, p=0.039) were identified for medical complications amongst male and female patients, respectively. Conclusions: Multiple preoperative serum values were predictive of postoperative medical complications, and laboratory value thresholds were identified in this carpal tunnel decompression cohort to aid in risk stratification.

Morbid obesity among Crohn's disease patients is on the rise and is associated with a higher rate of surgical complications after ileocolic resection.

Crohn's disease (CD) is regarded as a wasting disease, yet there is a growing population of CD patients with a body mass index (BMI) of 35 and above. The rate of postoperative complications is relatively high in CD patients but might be even higher in CD with morbid obesity (MO). This was a retrospective study using a prospectively maintained database of all patients undergoing Ileocolic resection for CD between 2014 and 2021 in two referral centres, comparing postoperative complication rates according to BMI. Three hundred and forty-six patients were identified. Sixty patients (17%) had a BMI over 30 kg/m2, and 28 (8.1%) had a BMI of over 35 kg/m2 (>35 group). The BMI >35 group had more women (78.6% vs. 52%, P < 0.1), a higher rate of patients not receiving an anastomosis (7.1% vs. 2.5%, P = 0.02), a higher rate of any postoperative surgical complication (32.1% vs. 25.2%, P = 0.4), with a higher rate of Clavien-Dindo ≥3 (14.3% vs. 7.2%, P = 0.25), a higher rate of stoma creation on reoperation for complications (7.2% vs. 1.7%, P = 0.04), a higher rate of 30-day readmission due to intra-abdominal abscess (10.7% vs. 4.7%, P = 0.2), but a lower rate of postoperative medical complications (3.6% vs. 15.7%, P < 0.01). The rate of MO among CD patients requiring ileocolonic resection is on the rise. MO in this setting is associated with statistically non-significant increases in all surgical complications, severe complications, readmission, and a higher chance for a bailout stoma creation upon reoperation. However, MO seems to be a protective factor for medical postoperative complications, which might suggest better nutritional status.

Research Progress on the Application of "Cocktail" Therapy in Total Knee Arthroplasty

Total knee arthroplasty is one of the important surgical methods for end-stage knee osteoarthritis in elderly patients. However, due to the large surgical trauma, postoperative pain may occur to varying degrees, which not only affects patients' functional exercise, delays limb rehabilitation and increases hospitalization time but also increases postoperative medical expenses and complications risks. In recent years, the widely used joint periarticular local infiltration "cocktail" has become an ideal combination therapy for multimodal analgesia. This method aims to prevent and control postoperative pain by co-injecting several drugs (formulated drugs) into the surrounding area of the joint. Currently, the "cocktail" formulation is constantly being improved, and there is still a lack of unified standards regarding its formulation, injection method, and site. This article will review recent research progress on the use of "cocktail" treatment in total knee arthroplasty both domestically and internationally.

Cirrhosis associated with increased complications and healthcare utilization following total shoulder arthroplasty

Introduction Cirrhosis is a known risk factor for morbidity and mortality following surgical procedures and has been associated with increased complications, hospital length of stay (LOS), and cost of admission following total joint arthroplasty. However, a paucity of literature exists evaluating the effect of cirrhosis on postoperative outcomes following total shoulder arthroplasty (TSA). The purpose of this study is to evaluate the short-term outcomes following elective primary TSA in patients with cirrhosis compared to matched controls. Methods The Nationwide Readmissions Database was queried from 2016 to 2020 to identify patients who underwent elective primary TSA. Patients with a diagnosis of cirrhosis ( n = 627) were matched in a 1:1 proportion to patients who did not have cirrhosis. Bivariate statistical analyses were performed to compare preoperative demographic and comorbidity data, postoperative outcomes, and hospital utilization metrics between the two groups. Following Bonferroni correction, an alpha value of 0.003 defined significance. Results Patients with cirrhosis exhibited higher rates of postoperative medical and implant-related complications following primary TSA, including acute renal failure (6.3% vs 1.1%: p &lt; 0.001), urinary tract infection (3.5% vs 0.6%; p &lt; 0.001), transfusions (3.0% vs 0.2%; p &lt; 0.001), acute respiratory distress syndrome (2.9% vs 0.2%: p = 0.002), surgical site infection (2.0% vs 0.2%: p = 0.001), dislocation (2.1% vs 0.0%: p &lt; 0.001), and prosthetic loosening (1.5% vs 0.0%; p = 0.002). These patients also exhibited higher rates of all-cause complications (32% vs 9.2%: p &lt; 0.001) and mortality (1.5% vs 0.0%; p = 0.002) within 180 days of surgery and had an increased cost of admission ($24,633 vs $18,500; p &lt; 0.001) and LOS (2.6 vs 1.5 days; p &lt; 0.001). Conclusion Patients with cirrhosis were found to have increased risk of medical and surgical complications, higher costs, and longer LOS following TSA. These findings can assist orthopedic surgeons in developing strategies in the preoperative period to mitigate complications in this at-risk patient group. Level of evidence Level III – Retrospective cohort study.

How Does Inflammatory Bowel Disease Impact Outcomes and Costs of Care Following Primary 1- to 2-level Lumbar Fusion for Degenerative Lumbar Disease?

Retrospective study. The purpose of this study was to determine whether IBD in patients with degenerative lumbar changes undergoing primary 1-2LF is associated with higher rates of (1) in-hospital length of stay, (2) medical complications, (3) readmissions, and (4) costs of care. In the United States, the prevalence of inflammatory bowel disease (IBD) has increased concurrently with an aging population with degenerative disk changes. In these patients, primary 1- to 2-lumbar fusion (1-2LF) is a common procedure to resolve serious complications of the spine. Studies comparing these patient demographics to hospital lengths of stay, postoperative complications, readmission rates, and costs of care are limited in the literature. The inclusion criteria consisted of patients with IBD who underwent 1-2LF, using a 90-day surveillance period, postoperatively. This 90-day surveillance period was used to measure the length of hospital stay, rates of medical complications, rates of readmissions, and overall costs of care. The IBD cohort was matched against a case-matched cohort group. Patients in the study group had significantly longer in-hospital lengths of stay. In addition, patients in the study group had significantly higher incidence and odds of developing postoperative medical complications within 90 days. Also, study group patients had significantly higher readmission rates. Finally, patients in the study group had significantly higher costs of care than their case-matched cohort. This study demonstrated that patients with IBD and degenerative lumbar disease are burdened with longer in-hospital lengths of stay, rates of postoperative medical complications, rates of readmission, and costs of care after undergoing primary 1-2LF.

Postoperative delirium following total joint arthroplasty: epidemiology, risk factors, and associated complications.

Postoperative delirium (POD) is a feared complication following major surgery in elderly patients. Further investigation of the risk factors and consequences of POD following total joint arthroplasty is warranted. Patients who underwent total knee arthroplasty (TKA) or total hip arthroplasty (THA) were identified using PearlDiver. Patients were filtered into 2 cohorts based on the presence or absence of POD within 7 days of surgery. Epidemiological analyses were performed to examine trends in POD following TKA and THA by age group and year. Comparative analyses were performed on patient demographics and baseline cognitive status. After matching by age, sex, and comorbidities, electrolyte disturbances and 90-day postoperative complications were analysed. Among 2,518,918 (99.7%) no POD and 7240 (0.3%) POD patients who underwent total knee or hip arthroplasty, mean age was 65.58 years, 60.2% were female, and mean CCI was 1.50 for the whole cohort. POD patients frequently had baseline cognitive impairment (P < 0.001). Incidence of POD decreased from 0.54% in 2010 to 0.10% in 2022 (P < 0.001) and increased with age (P < 0.001). POD patients had higher 90-day costs (TKA = $19,572 vs. $10,397, P < 0.001; THA = $18,496 vs. $9,877 P < 0.001). After matching, POD TKA patients had higher rates of hypernatraemia (6.1% vs 4.5%, P = 0.001) and POD THA patients had higher rates of hyponatraemia (26.5% vs 23.1%, P = 0.008). POD patients had higher rates of 90-day postoperative medical and surgical complications (P < 0.05) than no POD patients. Nearly 0.3% of patients who underwent either TKA or THA between 2010 and 2022 developed transient delirium. POD was most common in elderly patients with baseline cognitive impairment undergoing revision surgery. POD patients had higher rates of 90-day postoperative surgical and joint-related complications. While POD rates have decreased, continued initiative to prevent POD in total joint arthroplasty patients is imperative.

Extraperitoneal Robot-Assisted Laparoscopic Radical Prostatectomy in Continuous Spinal Anesthesia: A New Approach to an Established Technique.

Background and Objectives: To prove the feasibility of continuous spinal extraperitoneal robot-assisted laparoscopic radical prostatectomy (cseRALP) in order to expand the pool of eligible patients. Materials and Methods: According to IDEAL guidelines, a consecutive cohort of patients who underwent cseRALP was enrolled. Pre-, intra-, and post-operative data were collected, with particular focus on safety and oncological outcomes. Results: A total of three patients underwent this technique, with no intra- or post-operative medical complications. Only a grade 1 Clavien-Dindo complication was reported, small urinary leakage treated with an indwelling catheter. Oncological and functional results at month 3 were satisfactory, with no recurrence and no stress incontinence. Conclusions: cseRALP seems to be feasible and safe; further trials are mandatory.

Language Preference, Surgical Wait Time, and Outcomes Among Older Adults With Hip Fracture

Patients with a non-English language preference served within English-dominant health care settings are at increased risk of adverse events that may be associated with communication barriers and inequitable access to care. To investigate the association of non-English language preference with surgical wait time and postoperative outcomes in older patients undergoing hip fracture repair. This population-based, retrospective cohort study was conducted using linked databases to measure surgical wait time and postoperative outcomes among older adults (aged ≥66 years) in Ontario, Canada, who underwent hip fracture surgery between January 1, 2017, and December 31, 2022. Propensity-based overlap weighting accounting for baseline patient characteristics was used to compare primary and secondary outcomes. Non-English language preference. The primary outcome was surgical delay beyond 24 hours. Secondary outcomes included time to surgery, surgical delay beyond 48 hours, postoperative medical complications, length of stay, discharge destination, 30-day mortality, and 30-day hospital readmission. Among 35 238 patients who underwent hip fracture surgery, 28 815 individuals (81.8%) were English speakers (mean [SD] age, 84.4 [8.0] years; 19 965 female [69.3%]) and 6423 individuals (18.2%) were non-English speakers (mean [SD] age, 85.5 [7.0] years; 4556 female [70.9%]). The median (IQR) wait time for surgery was similar for English (24 [16-41] hours) and non-English (25 [16-42] hours) speakers. There was no significant difference in surgical delay beyond 24 hours between English-speaking and non-English-speaking patients (3321 patients [51.7%] vs 14 499 patients [50.3%]; adjusted relative risk [aRR], 1.00; 95% CI, 0.98-1.03). Compared with English speakers, patients with a non-English language preference had increased risk of delirium (4207 patients [14.6%] vs 1209 patients [18.8%]; aRR, 1.10; 95% CI, 1.03-1.17), myocardial infarction (150 patients [0.5%] vs 43 patients [0.7%]; aRR, 1.52; 95% CI, 1.04-2.22), longer length of stay (median [IQR], 10 [6-17] vs 11 [7-20] days; aRR per 1-day increase, 1.11; 95% CI, 1.06-1.15), and more frequent discharge to a nursing home (1814 of 26 673 patients surviving to discharge [6.8%] vs 413 of 5903 patients surviving to discharge [7.0%]; aRR, 1.13; 95% CI, 1.01-1.27). In this study of older adults with hip fracture, non-English language preference was associated with increased risk of delirium, myocardial infarction, longer length of stay, and discharge to a nursing home. These findings suggest inequities in hip fracture care for patients with a non-English language preference.

Protein as a preoperative predictor – Impact of hypoalbuminemia on 30-day outcomes of breast reduction surgery

Hypoalbuminemia, a biomarker of malnutrition, has been associated with adverse surgical outcomes;, however, its impact on breast reduction surgery is not yet well-documented. We queried the American college of surgeons national surgical quality improvement program database to identify patients who underwent breast reduction surgery between 2008 and 2022. Patients were grouped by preoperative normal albumin levels (≥3.5g/dL) and hypoalbuminemia (<3.5g/dL). Preoperative, intraoperative, and 30-day postoperative outcomes, including complications and readmissions, were compared using the univariate tests and multivariable logistic regression. We included a total of 7277 cases, among whom 96% (n=6964) had normal albumin values and 4% (n=298) had hypoalbuminemia (n=298). Patients with hypoalbuminemia showed a significantly higher body mass index (37.1±8.1 vs. 33.3±6.3kg/m², p<0.001) and were more likely to be Black or African American (49.0 vs. 27.8%, p<0.001). Comorbidities such as diabetes (14.7 vs. 7.4%, p<0.001), chronic obstructive pulmonary disease (4.0 vs. 1.0%, p<0.001), and hypertension (35.2 vs. 26.3%, p=0.002) were significantly more prevalent in the hypoalbuminemia group. Hypoalbuminemia was associated with a significantly increased risk of complications (13.8 vs. 6.1%, p<0.001), with higher rates of superficial incisional infections (7.0 vs. 2.6%, p=0.001) and unplanned readmissions (3.4 vs. 1.4%, p=0.05). Multivariable analysis confirmed hypoalbuminemia as an independent predictor of postoperative complications (OR 1.96, p=0.001), medical complications (OR 2.62, p=0.02), and surgical complications (OR 1.91, p=0.02). Hypoalbuminemia significantly raises the risk of 30-day postoperative complications in breast reduction surgery. Preoperative nutritional assessment and optimization are crucial in improving surgical outcomes, particularly in patients with high body mass index and comorbidities.

Smokeless tobacco use is associated with a lower risk of perioperative complications and revision surgery after anatomic and reverse total shoulder arthroplasty compared to cigarette smokers

BackgroundNo prior study has separated the effects of smokeless tobacco from traditional cigarettes in patients undergoing anatomic total shoulder (aTSA) and reverse total shoulder arthroplasty (rTSA). Therefore, the purpose of this study was to evaluate the effects of smokeless tobacco on postoperative outcomes after aTSA and rTSA. MethodsA retrospective cohort study utilizing a large insurance database was conducted. Patients undergoing primary TSA with a minimum two-year follow-up were included. Smokeless tobacco only users, cigarette only users, and nontobacco users were propensity score matched based on demographic variables and comorbidities. Postoperative medical complications and surgery-specific complications were compared among groups. Patient groups were further stratified by surgical technique: aTSA or rTSA. Multivariable logistic regressions were employed to account for confounding variables. ResultsSmokeless tobacco use was not associated with increased risk of complications after TSA compared to nonusers. Cigarette use was associated with an increased risk of pneumonia (OR: 1.20), wound dehiscence (OR: 1.39), emergency department (ED) visits (OR: 1.40), and readmissions (OR: 1.12) within 90 days as well as infection (OR: 1.21), aseptic loosening (OR: 1.28), dislocation (OR: 1.27), fracture (OR: 1.30), and revision surgery (OR: 1.19) within 2 years compared to nonusers. After separating by surgical technique, smokeless tobacco use, after aTSA was associated with fewer 90-day ED visits (OR: 0.52), while cigarette only use was associated with increased risk of rotator cuff tear (OR: 1.17) and fracture (OR: 1.88) within two years compared to nonusers. Compared to cigarette smokers, smokeless tobacco users had significantly decreased risk of ED visits (OR: 0.40) within 90 days and implant removal (OR: 0.13) within two years of surgery. For rTSA, smokeless tobacco use was not associated with increased risk of complications compared to nonuser controls; however, cigarette use was associated with an increased risk of ED utilization (OR: 1.33) within 90 days as well as aseptic loosening (OR: 1.32) and irrigation and debridement (OR: 1.37) within two years. Smokeless tobacco use, when compared to cigarette users, was associated with significantly fewer shoulder dislocations (OR: 0.27) within two years. ConclusionSmokeless tobacco use was associated with a lower risk of complications compared to cigarette users and no difference compared to nonusers after aTSA and rTSA. These findings suggest that while all tobacco use, including smokeless tobacco and cigarettes, is best avoided prior to surgery, the risks associated with smokeless tobacco use may be less severe than those linked to cigarette smoking after aTSA and rTSA.

Glucagon-like Peptide-1 Receptor Agonist Use is Associated With Increased Risk of Perioperative Complication and Readmission Following Shoulder Arthroplasty

Glucagon-like peptide-1 (GLP-1) receptor agonists, increasingly used for diabetes management and weight loss, have been linked to lower readmission rates after knee and hip arthroplasty. However, their impact on total shoulder arthroplasty (TSA) outcomes remains unclear. This study investigates the effects of GLP-1 receptor agonists on major complications and revisions following TSA. A retrospective query of the TriNetX database from 2010 to 2023 was performed to identify patients who underwent anatomic or reverse TSA and were prescribed GLP-1 receptor agonists. GLP-1 receptor agonist users were 1:1 propensity score-matched to controls for demographic factors and comorbidities, yielding 1,259 patients in each group. Outcomes included 90-day postoperative medical complications and readmission and revision surgery at 2 years. Odds ratios (ORs), 95% confidence intervals, and P values were calculated. After Bonferroni correction, P < 0.005 was considered significant. GLP-1 receptor agonist users (n = 1,259) experienced significantly higher rates of deep vein thrombosis (1.6% vs. 0.9%; OR 3.0; P = 0.001), myocardial infarction (1.60% vs. 0.9%; OR 2.84; P = 0.003), pneumonia (3.34% vs 1.50%; OR 2.25; P = 0.003), transfusion (7.1% vs. 4.3%; OR 1.7; P = 0.003), and readmission (8.1% vs 5.2%; OR 1.6; P = 0.004) in the 90-day postoperative period compared to patients not taking GLP-1 receptor agonists. There were no differences in the rates of stroke, pulmonary embolism, postoperative anemia, or renal failure. In patients with a minimum 2-year follow-up (n = 776), there was no difference in revision rate (3.2% vs 1.8%; OR 1.8; P = 0.07). GLP-1 receptor agonist use during TSA was associated with an increased risk of deep vein thrombosis, myocardial infarction, pneumonia, need for transfusion, and readmission. Further investigation into the perioperative risk assessment and medical optimization of patients utilizing GLP-1 receptor agonists may be warranted.

Can abdominal aortic calcification detected on lateral lumbar radiography predict instrument-related complications in patients undergoing posterior lumbar fusion?

Objective: Abdominal aortic calcification (AAC) is well known as a useful and simple clinical indicator of the risk of fracture and cardiovascular disease. However, no studies have directly compared the postoperative implications of AAC in spinal surgery. The purpose of this study was thus to examine whether extended AAC (scores ≥5) negatively affected clinical outcomes after posterior lumbar fusion with instrumentation for degenerative lumbar stenosis or degenerative spondylolisthesis.Methods: The subjects comprised 101 consecutive patients with spinal stenosis or degenerative spondylolisthesis who underwent posterior lumbar fusion and instrumentation between January 2016 and January 2019 and were followed for over 2 years. Propensity score matching was employed to assemble patient groups with similar baseline characteristics. Postoperative complications and radiologic outcomes were compared between the groups (33 patients in each) divided by extended AAC score.Results: The incidence rates of junctional failure (6.1% vs. 30.3%, P=0.008) and screw-related complications (12.1% vs. 36.4%, P=0.019) were higher in the extended AAC group than in the mild AAC group. However, the rates of adjacent segment disease (24.2% vs. 36.4%, P=0.283) and revision (6.1% vs. 9.1%, P=0.642) were not significantly different between the 2 groups. In terms of postoperative medical complications, cardiovascular and cerebrovascular diseases were significantly more common in the extended AAC group than in the mild AAC group (0% vs. 15.2%, P=0.020).Conclusion: Extended AAC indicates increased risk for postoperative junctional failure and screw-related complications, regardless of age, osteoporosis, and comorbidities.

Effects of sarcopenia and nutritional status on surgical outcomes for metastatic spinal tumors: In the perspective of peri-operative complications and performance improvement.

With the advancement of cancer treatment, appropriate treatment for musculoskeletal problems is becoming more important as it extends the patient's lifespan and improves the quality of life. In surgical treatment for metastatic spine tumors (MST), various efforts are being considered to obtain a good prognosis. The purposes of this study are to analyze prognostic factors for postoperative ambulation and perioperative complications in patients surgically treated for MST with neurologic symptoms. Seventy five cases of patients who underwent surgery for MST with neurologic symptoms were enrolled between December 2016 and January 2023. Postoperative ambulatory function and medical complications were assessed for each patient in this study. The endpoint of ambulatory function was defined as the best function among entire periods of follow-up outpatient visits. We defined the improvement of ambulatory function as improvement in Eastern Cooperative Oncology Group (ECOG) scale. For complications, we applied complication classification system for orthopaedic surgery. Perioperative complications were defined as those requiring changes of treatment compared with routine postoperative treatment during patient's admission. Confirmed complications included expire, delirium, urinary tract infection (UTI), pneumonia, sepsis, bacteremia, acute kidney injury (AKI), chylothorax. Prognostic factors were collected and analyzed for relationship by logistic regression. Of the 75 cases, postoperatively 42 (56%) cases of patients were improved in Nurick grade, 36 (48%) cases of patients in ECOG performance. And 21 (28%) cases of patients were treated in intensive care unit (ICU) and 15 (20%) cases of patients suffered from major perioperative complications. Regression analysis showed that clinical factors such as ECOG, psoas muscle index (PMI) and prognostic nutritional index (PNI) were related to the improvement of ambulatory function and incidence of perioperative complications. On multivariate analysis, improvement of ambulatory function was associated with PMI (p = 0.014) and incidence of perioperative complications was associated with PNI (p = 0.045). Preoperative nutritional status and sarcopenia are related factors in the outcome of surgical treatment for MST, and preoperative efforts to improve these may be a way to obtain better clinical results.

Impact of anesthesia type on surgical outcomes and medical complications in chronic subdural hematoma surgery

BackgroundsChronic Subdural Hematoma (CSDH) is common in elderly patients. Although general anesthesia (GA) has traditionally been used for CSDH surgeries, it may lead to postoperative complications, especially in older patients. We hypothesized that local anesthesia (LA) could reduce postoperative medical complications, including pneumonia, compared to GA. MethodsWe conducted a retrospective study from 2015 to 2019, of medical records of CSDH patients from two hospitals in addition to a comprehensive literature review. Inclusion criteria were a new CSDH diagnoses and treatment with burr-hole craniostomy (BHC) and drain insertion. Patients with recent ipsilateral craniotomies were excluded. Clinical variables included demographics, comorbidities, hematoma characteristics, and post-operative outcomes. ResultsOf 383 eligible patients, 63 underwent BHC under LA (LA group), and 320 under GA (GA group). Both groups exhibited similar baseline characteristics, hematoma characteristics, and surgical outcomes, including postoperative CT findings and ICU stay duration. There was also no significant difference in postoperative bleeding events between the groups. Although patients in the GA group experienced a higher incidence of postoperative pneumonia (3.8 % vs 1.6 %), multivariate analysis revealed that the occurrence of pneumonia was associated with a history of lung disease and preoperative neurological status (OR 7.28, p = 0.018, OR 3.40, p < 0.001, respectively) rather than with the type of anesthesia used. ConclusionOur study suggests that the type of anesthesia does not influence postoperative surgical and medical outcomes, including pneumonia, which is the most common medical complication of BHC for CSDH. Rather, preoperative neurological status and underlying morbidities appear to be more closely related to postoperative medical complications. Future large, prospective studies are needed to validate our findings.

Arthroscopy Within Three Months Prior to Unicompartmental Knee Arthroplasty Is Associated With an Increased Rate of Periprosthetic Joint Infection

BackgroundArthroscopy remains a commonly performed procedure in patients who have meniscal or other osteochondral pathology prior to ultimately being indicated for unicompartmental knee arthroplasty (UKA). The purpose of this study was to examine the timing of knee arthroscopy prior to UKA and its association with 2-year periprosthetic joint infection (PJI) rates and medical and surgical complications. MethodsPatients undergoing UKA who had history of ipsilateral arthroscopy within 2 years prior to the UKA were identified in a national insurance database. A control cohort of propensity matched patients who did not have a history of arthroscopy was identified. Study cohorts were established based on timing of the arthroscopic procedure: 0 to 3, 3 to 6, 6 to12, and 12 to 24 months prior to UKA. Patients were included if they had 2-year postoperative follow-up after UKA. The 90-day rates of postoperative medical and 2-year surgical complications were recorded. Multivariate analysis was conducted to account for confounding variables and covariates. ResultsA final cohort of 3,471 patients met inclusion criteria. Patients undergoing UKA within three months of the arthroscopic procedure demonstrated a higher incidence of PJI when compared to the control cohort (3.30 versus 1.12%, P = 0.012). In addition, there was an increased rate of periprosthetic fracture observed in those undergoing UKA within three months of arthroscopy when compared to the control (1.10 versus 0.20%, P = 0.010). ConclusionsPatients undergoing ipsilateral arthroscopy within three months of a UKA demonstrated a nearly 3-fold increased incidence of PJI when compared to the control. There was no increased incidence of PJI when UKA was staged greater than three months after arthroscopy. These findings provide insight for preoperative considerations for arthroplasty surgeons in this patient population. Level of EvidenceLevel III, retrospective comparative study.

Body Mass Index and the Risk of Postoperative Complications After Total Knee Arthroplasty.

Given the growing prevalence of obesity, it is crucial to understand the effect of obesity on complications after total knee arthroplasty (TKA). This study aims to assess the relationship between body mass index (BMI) and postoperative periprosthetic joint infection (PJI), medical complications, and surgical complications after TKA. The Premier Healthcare Database was used to identify all primary elective TKAs between 2016 and 2021. The primary outcome was risk of PJI within 90 days of surgery. Using logistic regression, restricted cubic splines were generated to assess the relationship between BMI as a continuous variable and PJI risk. Bootstrap simulation was then done to identify a BMI inflection point on the final restricted cubic spline model past which the risk of PJI increased. The relationship between BMI and composite 90-day medical and surgical complications was also assessed. A direct relationship was observed between increasing BMI and increasing risk of PJI with a BMI changepoint of 31 kg/m 2 identified as being associated with increased risk. Above a BMI of 31 kg/m 2 , there was an average relative risk increase of PJI of 13.6% for every unit BMI. This relative risk per unit BMI increased from 5.8% for BMI 31 to 39 to 11.5% between BMI 40 and 49 kg/m 2 , and 21.3% for BMIs ≥50 kg/m 2 . Similarly, a direct relationship was also found between increasing BMI and both medical and surgical complications with BMI changepoints of 34 and 32 kg/m 2 identified, respectively. Obese patients with a BMI >31 kg/m 2 were at increased risk of PJI. Although the relative risk increase was small per unit BMI above 31 kg/m 2 , the cumulative increase in risk may be marked for patients with higher BMIs. These data should be used to inform discussions that involve shared decision making between patients and surgeons who weigh the risks and benefits of surgery.

Cannabis Use and Increased 90-Day Postoperative Medical Complications Following Foot and Ankle Arthrodesis

Category: Ankle; Midfoot/Forefoot Introduction/Purpose: As medical and recreational cannabis use continues to increase in prevalence across the United States, it is important to understand the impacts of sustained cannabis use on one’s health. Previous literature has shown the potential for cannabidiol products to aid in the improvement of some osteoarthritic symptoms. However, there is a paucity of literature examining the relationship between cannabis use and postoperative medical outcomes for end stage osteoarthritis management, including procedures such as foot and ankle arthrodesis. Therefore, the purpose of this study was to investigate the relationship between cannabis use and the incidence of medical complications within 90 days of foot or ankle arthrodesis. Methods: A retrospective review of a national insurance claims database was performed from 2010 to 2022. CPT codes were used to identify patients who underwent arthrodesis of the ankle, subtalar, talonavicular, calcaneocuboid, naviculo-cuneiform, midtarsal, tarsometatarsal, metatarsophalangeal, or interphalangeal joints. Of those patients, those with established diagnoses of cannabis use disorder, cannabis dependency, or cannabis addiction were identified using ICD-9 and -10 codes. This cannabis cohort was matched 1:4 on the basis of age, sex, and Charlson Comorbidity Index (CCI) to a control cohort without a history of cannabis use to remove potential confounding upon comparison. Demographic and comorbidity profiles, as well as medical and surgical post-operative outcomes were compared using Chi-square tests. Results: Out of 192,162 patients undergoing foot or ankle arthrodesis, 6,387 had a documented history of cannabis use. Compared to controls, the cannabis cohort was significantly younger (mean age 44.1 vs. 56.5; p&lt; 0.001), exhibited a higher comorbidity burden (mean CCI 1.59 vs. 1.38; p&lt; 0.001), and had a greater proportion of male patients (48.2% vs. 31.9%; p&lt; 0.001). Post-matching for age, CCI, and sex, cannabis users demonstrated a significantly higher incidence of medical complications within 90 days of their index ankle fracture ORIF procedure. Notably, cannabis users exhibited elevated rates of various complications, including pneumonia, deep venous thrombosis, pulmonary embolism, myocardial infarction, stroke, surgical site infection, cardiac arrest, acute kidney injury, urinary tract infection, sepsis, and hypoglycemia compared to matched controls (all p&lt; 0.001). Conclusion: Cannabis use is associated with increased incidences of many serious medical complications within 90 days of foot or ankle arthrodesis. These results may help better inform physicians and patients about the increased postoperative risks cannabis users may face, which may lead to the implementation of tailored perioperative care. Further, these results emphasize the need for further research on the molecular mechanisms of cannabis to understand the risk-benefit ratio between the therapeutic effects of cannabidiol for arthritic pain relief, and the adverse outcomes that may result following surgical intervention.