Patient Demographics Research Articles

Fixing Cho Type IIC Distal Clavicle Fractures with Hook Plates Leads to a High Incidence of Subacromial Osteolysis: A Retrospective Study and Literature Review.

This retrospective study investigates the complications, particularly subacromial osteolysis (SAO), associated with hook plate (HP) fixation, in the treatment of unstable distal clavicle fractures characterized by complete coracoclavicular (CC) ligament rupture. The decision-making process for employing HP in fractures of this nature, such as Neer types IIB and V and Cho classification IIC, involves considerations of distal fragment size and displacement. While HP offers advantages in clinical practice, it is not without complications, with SAO being a notable concern. Factors such as non-anatomic hook tip placement and fracture classification may influence the risk of SAO. The study comprises a retrospective analysis of unstable distal clavicle fractures treated with HP at our institution from 2019 to 2022. Exclusions include non-displaced fractures, those treated with other locking plates, and pathologic fractures. A total of 91 patients with displaced distal clavicle fractures underwent open reduction and internal fixation with HP. Cho classification was employed to differentiate cases with CC ligament rupture. Patient demographics, classifications, postoperative radiographs, distal fragment size, plate position, timing of implant removal, and complications, including SAO, were recorded. Among the 91 patients, 32 were classified as Cho IIB, 43 as Cho IIC, and 16 as Cho IID. Ninety-one percent exhibited solid union before implant removal. The prevalence of SAO was 43.8%, 76.7%, and 62.5% in Cho IIB, IIC, and IID, respectively. Univariate analysis revealed a significant difference only in Cho classification (p = 0.014). Binary logistic regression identified Cho classification type IIC as the sole risk factor for SAO (p = 0.021; odds ratio, 4.48; 95% confidence interval, 1.56-12.87). Cho type IIC fractures, characterized by CC ligament deficiency causing horizontal instability, demonstrated the highest SAO rate. In contrast, Neer type IIB fractures retained the trapezoid ligament, and Neer type V fractures had intact CC ligaments, resulting in lower SAO rates. Biomechanically, combining HPs with CC ligament reconstruction provided better structural stability than using HPs alone in treating Cho type IIC fractures.

356 Variation in Duration of Emergency Department Boarding by Patient Demographics

356 Variation in Duration of Emergency Department Boarding by Patient Demographics

Cardiac implantable electronic device patient follow-up: Assessment of U.S. practice

BackgroundA 2015 expert consensus statement recommended that patients with cardiac implantable electronic devices receive remote monitoring and at least 1 in-office evaluation annually. ObjectiveThe purpose of this study was to examine whether patients who underwent implantation of a new cardiac implantable electronic device received care concordant with consensus statement recommendations. MethodsWe examined the rate of follow-up office visits and remote monitoring for 211,346 Medicare beneficiaries with an implantation of a new cardiac implantable electronic device between October 2015 and December 2020. We also assessed the characteristics of patients receiving follow-up care. ResultsWithin 16 weeks of implantation 77.8% of patients were seen in-office for a postoperative evaluation. The percentage of patients seen in office was 85.9% in the first 12 months, with 64.2% of patients seen in office every 2 years postimplantation, respectively. Following implantation, the percentage of beneficiaries receiving remote monitoring in the first 91 days was 14.7%, with 4.4% patients receiving remote monitoring every 91 days postimplantation within the first year. Patients who were ≥85 years old, nonwhite, or of lower income were less likely to receive office visits postimplantation. ConclusionsAlthough most Medicare beneficiaries were seen in-office in the year following a new implant, the percentage of beneficiaries with an in-office visit declined in subsequent years. Fewer than 5% of beneficiaries had remote monitoring at the frequency recommended by the expert consensus statement. Patient demographics, including older age, nonwhite race, and lower income were associated with a lower likelihood of receiving care concordant with consensus statement recommendations.

Subgingival Yeasts Species Amongst Smokers and Nonsmokers With Peri-implantitis

There is a dearth of studies that have assessed yeast species in the subgingival biofilm (SB) samples collected from smokers and nonsmokers with peri-implantitis. This study assesses peri-implant clinical and radiographic profiles and yeasts species in the subgingival SB of cigarette smokers and nonsmokers with peri-implantitis. Participants were divided into 3 groups: group 1, cigarette smokers with peri-implantitis; group 2, nonsmokers with peri-implantitis; and group 3, nonsmokers without peri-implantitis. Information on smoking pack-years and patient demographics was collected. Implant-related parameters were retrieved from health care records. Peri-implant modified plaque and gingival indices (mPI and mGI, respectively), probing depth (PD), and crestal bone loss (CBL) were recorded. The SB samples were collected, subgingival yeasts colonisation was recorded, and yeasts species were identified. P < .05 was considered statistically significant. Respectively, 22, 22, and 24 individuals were included in groups 1, 2, and 3. In group 1, cigarette smokers had a smoking history of 29.7 ± 7.9 pack-years. The PD, mPI, and mesial and distal CBL were higher in groups 1 (P < .01) and 2 (P < .01) than in group 3. The mGI was higher in group 2 (P < .01) than in groups 1 and 3. The total number of implants in groups 1, 2, and 3 were 22, 22, and 24, respectively. In group 3, implants were in function for a longer duration (12.2 ± 2.3 years; P < .05) than in groups 1 (5.6 ± 1.9 years) and 2 (5.1 ± 0.7 years). Yeasts levels in CFU/mL were higher in group 1 than in groups 2 (P < .05) and 3 (P < .05); they were also higher in group 2 than in group 3 (P < .05). Candida albicans was the most isolated yeasts species, followed by Candida tropicalis, in all groups. Cigarette smokers and nonsmokers present similar peri-implant clinicoradiographic profiles, and oral yeasts (predominantly C albicans) seem to play a role in the progression of peri-implant disease in these individuals.

Real World Outcomes In Patients With Recurrent, Advanced Or Metastatic Endometrial Cancer Treated With Lenvatinib Plus Pembrolizumab

ObjectivePatients with endometrial cancer who progress following first line therapy have improved survival outcomes with pembrolizumab and lenvatinib (pem/len) compared with standard of care chemotherapy, as demonstrated in KEYNOTE-775. This was in a group of trial patients with a good performance status and excluded those with carcinosarcoma histology. In KEYNOTE-775 pem/len was associated with significant toxicity leading to dose reductions, treatment cessation and patient morbidity. We set out to assess the tolerability, toxicity and outcomes following pem/len for patients with recurrent, advanced or metastatic endometrial cancer in a real-world setting. MethodsUK centres treating patients with pem/len for advanced endometrial cancer within the compassionate access programme were approached. Retrospective data was analysed for those treated between May 2022 and June 2023. Data on patient demographics, treatment, toxicity and outcomes was extracted from medical records. Toxicity and tolerability were compared in those over and under the age of 70. Results7 centres returned data for 70 patients. Median age of patients was 68.5 years (range 45-85) with a performance status of 0-1 in 77.1% and of 2 in 22.9%. Histological subtypes included serous (34.3%), endometrioid (32.9%), carcinosarcoma (14.3%), clear cell (7.1%), mixed (2.9%) and other (8.6%). Grade ≥3 toxicity was reported in 55.7% with any-grade toxicity observed in 85.7%. In those aged ≥70 years (n=30) the rate of grade ≥3 toxicity was 60.0%. Rates of dose reduction of lenvatinib were 64.3% and toxicity-related treatment interruption 45.7%. The 6-month progression-free and overall survival rates were 54.0% (95%CI: 39.0-66.8) and 70.1% (95%CI:56.5-80.1) respectively. ConclusionThis real-world, observational study of pem/len showed comparable tolerability, toxicity and outcomes to previously reported clinical trial data. Our cohort included patients with a poorer PS and a broader range of histological subtypes including carcinosarcoma.

Rates of Reporting and Analyzing Race and Ethnicity in Athlete-Specific Sports Medicine Research: A Systematic Review.

Race- and ethnicity-based differences in treatment access and outcomes have been reported in the orthopaedic sports medicine literature. However, the rate at which race and ethnicity are reported and incorporated into the statistical analysis of sports medicine studies remains unclear. To determine the rate at which race and ethnicity are reported and analyzed in athlete-specific sports medicine literature. Systematic review; Level of evidence, 4. Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, articles published by the 3 journals of the American Orthopaedic Society for Sports Medicine between 2017 and 2021 were considered for inclusion. Original sports medicine research studies that focused on athletes were included. Outcome measures included reporting and analysis of patient demographics (age, sex, race, ethnicity). Studies that included demographic variables in a multivariate analysis or that performed a race-/ethnicity-based stratified analyses were considered to have analyzed that variable. Studies that reported and/or analyzed patient demographics were examined. Chi-square tests were performed to determine statistical significance. A total of 5140 publications were screened, and 842 met the inclusion criteria. Age and sex were well reported (84.1% and 87.0%, respectively), while race (3.8%) and ethnicity (2.0%) were poorly reported. There was no difference in rates of reporting age, sex, race, or ethnicity between the American Journal of Sports Medicine (AJSM), the Orthopaedic Journal of Sports Medicine (OJSM), or Sports Health: A Multidisciplinary Approach (Sports Health). The rate of analysis was also calculated as a percentage of the studies that reported that variable. Of the studies that reported age, 38.5% analyzed age. Using this method, 26.2% of studies analyzed sex, 40.6% analyzed race, and 17.6% analyzed ethnicity. Although there was no difference in the overall rate at which studies from the 3 journals analyzed ethnicity, Sports Health studies analyzed age (P = .044), sex (P = .001), and race (P = .027) more frequently than studies published in AJSM and OJSM. Of the studies that analyzed race, most of those studies (8/13, 61.5%) found significant race-based differences in reported outcomes. This systematic review demonstrated that race and ethnicity are poorly reported and analyzed in athlete-specific sports medicine literature, despite the fact that a majority of studies analyzing race found significant differences between racial groups. Improved reporting of race and ethnicity can determine whether race- and ethnicity-based differences exist in patient interventions to ameliorate disparities in patient outcomes.

Development of a Uniform Apheresis Case Report Form forStandardized Collection of Apheresis Data.

Apheresis is performed worldwide for an increasing number of indications. The development of common data elements (CDE) for apheresis related areas may facilitate conduct of new research, enhance quality initiatives including benchmarking, and improve patient care. This report describes the systematic development of the Uniform Apheresis Case Report Form (UACRF) as part of the Apheresis in the United States (ApheresUS) program. A consensus panel of 17 diverse experts in apheresis, related specialties, and electronic case report form (eCRF), and database development was assembled. The panel met via online conferencing from November 17, 2020 to December 1, 2021. A draft document was posted online for public comment from October 11, 2021 to November 10, 2021. Feedback was collected using an online survey tool. The consensus panel revised the UACRF. This version was converted to an eCRF with additional changes made to improve usability in this format. The final version of the UACRF was created on August 24, 2023. The UACRF contains 16 modules: procedure and subject eligibility, patient demographics, general procedure information, laboratory parameters, vascular access, common procedure elements, eight procedure specific modules (mononuclear cell collection and seven therapeutic modalities), outcomes, and site information. A total of 137 data elements were created, including 57 with one or more subelements. The UACRF is the first systematic attempt to develop CDE for therapeutic apheresis and white blood cell collections. Further validation of the UACRF is necessary to confirm the tool's ability to collect the relevant data elements and determine the usability of the form.

Effectiveness and Safety of Cefiderocol in Clinical Practice for Treatment of Patients with Gram-Negative Bacterial Infections: US Interim Results of the PROVE Study.

The international PROVE retrospective chart-review study aims to assess the real-world effectiveness and safety of cefiderocol for treatment of patients with carbapenem-resistant Gram-negative infections. US centers selected hospitalized patients receiving their first cefiderocol treatment for ≥72hours for a Gram-negative bacterial infection (November 2020-March 2023). Patient demographics, clinical characteristics, hospitalization, course of infection, antibiotic use, clinical cure (excluding patients with a relapse/reinfection), clinical response at the end of treatment, microbiology, in-hospital all-cause mortality (IH-ACM) at Day 30, and safety were analyzed using descriptive statistics. This interim analysis included 244 patients. The most frequent infection sites were respiratory tract (55.7%), skin and skin structure (16.8%), and blood (9.8%). The median duration of cefiderocol use was 12 days (interquartile range 8-18.5). Clinical cure was reported for 64.8% (158/244) of patients, clinical response for 74.2% (181/244), and 9.4% (23/244) had relapse/reinfection; 30-day IH-ACM was 18.4% (45/244). Of 82 patients with monomicrobial Pseudomonas aeruginosa infections, 64.6% (n = 53) and 74.4% (n = 61) had clinical cure and clinical response, respectively, and 30-day IH-ACM was 25.6%. Among 43 patients with monomicrobial Acinetobacter baumannii infections, 60.5% (n = 26) and 74.4% (n = 32) had clinical cure and clinical response, respectively, and 30-day IH-ACM was 18.6%. Five patients experienced six adverse drug reactions (one serious event: interstitial nephritis/acute kidney injury), and cefiderocol was discontinued in two cases. Cefiderocol had similar clinical cure and response rates to previous retrospective studies and lower mortality. Cefiderocol was well tolerated in real-world settings in critically ill US patients with problematic Gram-negative pathogens.

E-scooter-related imaging: a new emerging high-energy trauma patient.

To quantify the volume and nature of radiological imaging performed for e-scooter related trauma presentations in a tertiary referral centre and to identify common radiological pattern of injuries. Our study received institutional review board approval. We retrospectively reviewed all anonymised radiological imaging studies performed in our institution for the term 'scooter' or 'e-scooter' between July 2020 and July 2021. The patient demographics, number of imaging studies performed and modality type as well as the nature of injuries identified were recorded. Within the study period, 147 patients with e-scooter-related injuries were referred for radiological imaging. Forty-two (29%) of those patients had positive radiological findings. The vast majority of injuries on radiographs were upper limb injuries typical of a fall on outstretched hand (FOOSH) pattern. Thirty-two patients (22%) required advanced diagnostics with CT or MRI with 11 of these patients having positive findings. Four patients suffered significant head injuries including skull fractures and/or intracranial haemorrhage. Five patients suffered facial bone fractures, and 2 suffered spinal fractures. One patient suffered a handlebar abdominal trauma with a resulting large bowel injury ultimately requiring bowel resection. E-scooter-related injuries represent a new and emerging high-energy trauma patient. These patients demonstrate injury patterns similar to other high-energy trauma such as road traffic accidents. Although the most common injuries are musculoskeletal upper limb injuries typical of FOOSH, a large proportion of these require advanced diagnostic imaging (CT, MRI) which were commonly positive for significant injuries.

The evolution of a large-scale facial gender affirmation program: A comparative outcomes analysis

BackgroundThe volume of facial feminization surgery (FFS) performed has increased tremendously over the last decade as new gender affirmation programs have formed. Advancements in surgical planning and treatment protocols have resulted in complex, multiprocedural FFS operations. This study examines the characteristics and outcomes of a large-scale FFS program over a 5-year lifespan. MethodsA retrospective analysis was performed of all patients who underwent FFS in a high-volume integrated healthcare system from program initiation in 2018-2019 (early cohort) to maturation in 2021-2022 (late cohort). Patient charts were reviewed for demographic factors, operative details, complications, postoperative Emergency Department or Urgent Care (ED/UC) visits, revisions, and readmissions. Patient characteristics and outcomes were compared between early and late cohorts. Results191 patients were included, with 109 in the early cohort and 82 in the late cohort. Patient demographics were similar except mean age (40.3 years early cohort versus 36.3 years late cohort, p=0.03). Patients in the late cohort had longer operations (5.40hours versus 6.16hours, p=0.008) with a greater percentage of patients receiving genioplasty, rhinoplasty, fat grafting, or lip lift. Despite this, fewer patients in the late cohort were admitted postoperatively (62.4% versus 13.4%, p<0.001). There were no differences in total complications, minor complications, revisions, ED/UC visits, or readmissions. However, major complications were significantly more common in the early cohort (4.6% versus 0.0%, p=0.05). ConclusionAs a nascent FFS program matures, the number of procedures in a single operation increased along with operative length. Major complications and postoperative admission rates decreased while total complications remained low.

Primary Arthrodesis or Open Reduction and Internal Fixation for Lisfranc Injuries: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Lisfranc injuries are often managed surgically with primary arthrodesis (PA) or open reduction and internal fixation (ORIF); however, neither approach has been shown to be superior. This systematic review and meta-analysis assessed randomized controlled trials (RCTs) to compare the functional and surgical outcomes of PA and ORIF in the treatment of Lisfranc injuries. This study was performed as per the PRISMA protocol. Database searches were conducted on Cochrane, Embase, and PubMed libraries. Five RCTs were identified for inclusion involving 241 patients, of which 121 underwent PA and 120 underwent ORIF. Statistically significant differences in visual analog scale pain score at 2 years (mean difference 0.89, 95% CI 0.18-1.59), patient satisfaction (OR 10.04, 95% CI 1.78-56.76), and all-cause return to surgery (OR 27.31, 95% CI 12.72-58.63) were observed, all favoring PA. There were no statistically significant differences between PA and ORIF with regard to American Orthopaedic Foot & Ankle Society midfoot scores at 2 years, 36-Item Short Form Health Survey (SF-36) scores, and unplanned return to surgery. This study showed significant improvement in pain at 2 years, patient satisfaction, and all-cause return to surgery favoring PA in all instances. Given ORIF often necessitates a second operation for hardware removal, it is to be expected that all-cause return to surgery is higher in ORIF groups. Overall, these results do not have the power to confer an advantage to a particular approach because of significant heterogeneity. Further studies should focus on larger patient cohorts and longer follow-up, or analysis stratified by patient demographics and injury presentation. In the absence of clinically significant differences, cost-benefit analyses should be considered to answer the question of whether to "fix or fuse" for Lisfranc injuries.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) in Romania: First case series of all documented cases

SummaryBreast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon malignancy linked to textured breast implants by moderate evidence in 2021. Documenting Romanian cases provides valuable insights into epidemiology, management, and outcomes, enhancing global understanding and informing clinical practices. Our objectives were to analyze BIA-ALCL cases in Romania, focusing on patient demographics, implant characteristics, clinical presentation, diagnostic methods, treatment, and outcomes.We conducted a retrospective review of all known BIA-ALCL cases in Romania, examining patient demographics, implant details, clinical presentation, diagnostic methods, and outcomes. Data sources included medical records, surgical reports, follow-up data, and implant characteristics like shape, texture, and manufacturer.The mean age at diagnosis was 44.4 years. All patients had textured implants and no replacements, 4 with aesthetic indication and 1 reconstruction. The mean time from implantation to diagnosis was 7.2 years. Clinical presentations were primarily late seromas, diagnosed through fine needle aspiration and immunohistochemistry. Treatments involved multidisciplinary teams, with bilateral en-bloc explantation and adjuvant therapies in two cases. One patient had immediate reconstruction with smooth implants and Acellular Dermal Matrix. No disease recurrence was observed post-treatment.The low BIA-ALCL prevalence in Romania estimated at 1:44,500 compared to the mean of 1:13,745 in Europe indicates the need for an increased awareness and tracking. Establishing mandatory national implant registries, pathology databases, and enhancing physician and patient education will help identify potential cases. All cases involved textured implants, highlighting the need for ongoing research to identify risk factors and guide surgeons consulting patients with these implants.

Improving NSAID Safety: The Role of Transdermal Ketoprofen in the Management of Musculoskeletal Pain and Inflammation

Pain and inflammation affect patients both acutely and chronically across all patient demographics. Often, the medications which are used to target musculoskeletal conditions are poorly tolerated due to various contraindications, drug interactions, and troublesome adverse events. The investigation and development of localized, externally applied NSAIDs is on the rise among researchers and pharmaceutical manufacturers, but research is still inefficient in determining the role in therapy of transdermal analgesics and anti-inflammatories. Compounding Pharmacies and FDA 503b Outsourcing Facilities aid in this critical endeavor through endogenous compounding and manufacturing (respectively) of transdermal analgesic formulations. This review summarizes the currently available data supporting the implementation of transdermal ketoprofen preparations in the management of musculoskeletal pain and inflammation. Externally applied NSAIDs are crucial in the development of pain management modalities which reduce the risk of numerous complications, including drug-drug interactions, conflicting comorbidities, and harmful systemic adverse events.

Association between malnutrition risk and healthcare utilization in a culturally diverse sample of ambulatory patients with cancer.

254 Background: Malnutrition is prevalent among cancer patients placing them at an increased risk for treatment-related complications and poor clinical outcomes. This study investigated the relationship between malnutrition risk and healthcare utilization in a diverse sample of adult ambulatory cancer patients from the Sylvester Comprehensive Cancer Center. Methods: A retrospective analysis was conducted with data collected through the My Wellness Check (MWC), an electronic health record (EHR)-based assessment. Malnutrition was assessed through the NUTRISCORE, an integrated and validated nutritional screening tool within MWC that evaluates self-reported weight loss, appetite, cancer type, and treatment modality to assess risk of malnutrition. A NUTRISCORE greater or equal to 5 is considered malnutrition risk. Time to an emergency room (ER) visit and hospitalization were calculated in days from the first MWC questionnaire assignment and the first event, respectively. All ER visits and hospitalizations in the University of Miami Health System, self-reported patient demographics, and clinical characteristics were captured from the EHR. Uni- and multi-variate logistic regression models were used to examine factors associated with malnutrition risk. For survival analyses, the Kaplan-Meier method was used to calculate the cumulative incidence function of events and the cox proportional hazards regression models adjusting for patient demographics and clinical characteristics. Results: A total of5,984 ambulatory patients completed the MWC assessment between October 2019, and August 2023, with 31.2% (n=1,868) identified at malnutrition risk (NUTRISCORE ≥5). Patients were predominately White (n=5,092, 85.2%), and Hispanic (n=2,341, 39.1%). Hematologic cancer was the most common diagnosis (n=1284, 21.5%) followed by malignancies in digestive system (n=903, 15.1%) and male genitourinary (n=892, 14.9%). After adjusting for covariates, patients at malnutrition risk were at significantly higher risk for both ER visits (HR 1.57, 95% CI; 1.29 - 1.91, p&lt;0.0001) and hospitalizations (17.4% vs. 7.4% at 100 days, p&lt;0.0001) compared to those with low malnutrition risk. Factors associated with malnutrition risk included Hispanic ethnicity (aOR 1.17, 95% CI; 1.01-1.35), fatigue (aOR 1.62, 95%CI; 1.07-2.45), declined physical function (aOR 1.75, 95% CI;1.37 - 2.24), physical inactivity (aOR 1.20, 95%CI;1.04 - 1.38) and low HRQOL (aOR 2.48, 95%CI; 1.93-3.19). Conclusions: Malnutrition was associated with higher healthcare utilization in a diverse sample of ambulatory cancer patients. Hispanic ethnicity and worse PROs are factors associated with higher risk for malnutrition. Results from this work underscore the need of early nutritional interventions to prevent malnutrition and improve clinical outcomes.

Analysis of hospitalization costs in adult inguinal hernia: based on quantile regression model.

Inguinal hernia repair is a common surgical procedure with significant variability in hospitalization costs. Traditional cost analysis methods often overlook the distribution of costs across patient demographics and clinical factors. This study employs a quantile regression model to explore the determinants of hospitalization costs for adult inguinal hernia surgery, providing a detailed understanding of cost variations across different quantiles. We analyzed data from adult patients who underwent inguinal hernia surgery at Beijing Chaoyang Hospital from January 2015 to June 2023. The study included patient demographics, hernia-related information, surgery-related details, and cost-related data. A quantile regression model was used to assess the impact of various factors on hospitalization costs at different quantiles (10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%). Data were processed using StataSE 15.0 software. Our study included 16,602 patients, predominantly male (91.86%) and Han Chinese (96.48%), with the 51-64 years age group being the largest (26.80%). The quantile regression analysis revealed significant cost variations across different quantiles. Younger patients incurred higher costs, with age coefficients ranging from -40.541 at the 90th quantile to -3.082 at the 10th quantile. Uninsured patients faced higher costs, with coefficients from 214.747 at the 80th quantile to 501.78 at the 10th quantile. Longer hospital stays correlated with increased costs, with coefficients from 342.15 at the 80th quantile to 405.613 at the 90th quantile. Patients hospitalized multiple times(≥3) had lower costs, with coefficients from-767.353 at the 40th quantile to -311.575 at the 80th quantile. Comorbidities significantly raised costs, with coefficients for three or more comorbidities ranging from806.122 at the80th quantile to1,456.02 at the40th quantile. Laparoscopic surgery was more expensive than open surgery, with coefficients from 1,834.206 at the 80th quantile to 2,805.281 at the 10th quantile. Bilateral surgeries and the use of biological mesh also resulted in higher costs, with coefficients for bilateral surgeries ranging from 1,067.708 at the 10th quantile to 2,871.126 at the 90th quantile and for biological mesh from 3,221.216 at the 40th quantile to 6,117.598 at the 90th quantile. Hospitalization costs for inguinal hernia surgery are influenced by multiple factors, with significant variations across different patient groups. Strategies to control costs should be tailored to address the specific needs of patients, optimize surgical methods, and improve perioperative care. Future research should extend these findings across different healthcare settings and consider the latest advancements in medical technology and policy changes.

Pelvic Stress Fractures Following Resection and Reconstruction of Pelvis Tumours—An Observational Study

Background and Aims: Pelvic bone tumours are rare, with a guarded prognosis despite advances in radiological imaging and surgical techniques. Despite this, limb salvage surgery has become the mainstay treatment for patients presenting with primary bone sarcomas, especially those with low histological grade variants. However, the rate of peri-operative-associated complications remains high in the form of local recurrence and surgical site infections (SSI). Objective: We highlight our experience from a tertiary referral oncology centre of incidence and clinical and radiological features, as well as discuss the risk factors for developing pelvic stress fractures (PSFs) in patients treated with hemipelvis resection. Materials and Methods: We performed a retrospective search from our radiology and oncology database at our tertiary orthopaedic oncology referral centre for patients referred, diagnosed and managed for stress fractures following an internal hemipelvectomy for pelvic tumours/Sarcoma through the service between 2007 and 2019. Patient demographics, clinical characteristics, complementary imaging, clinical management outcome and peri-operative complications were documented. A focussed evaluation of patients diagnosed and managed for PSFs in patients treated with hemipelvis resection. Results: We identified a total of six patients with stress fractures following internal hemipelvectomy. The sacrum was the most common anatomical region ( n = 3). Other areas identified with insufficiency stress fractures included the ischium and femoral neck. Conclusion: Stress fractures post pelvis resection and reconstruction is a rare complication. Radiologists and orthopaedic oncology surgeons need to be aware of this complication to aid with an early diagnosis and initiate appropriate management.

Differences in Symptom Burden in Primary Brain Tumor Patients Based on Sex, Race, and Ethnicity: a Single-Center Retrospective Study.

Symptom burden affects quality of life and prognosis in primary brain tumor (PBT) patients. Knowing whether symptom burden varies based on sex, race, or ethnicity may affect the interpretation of the relationship between symptoms and survival may reveal issues with applying the tools to measure symptom burden to different groups and may identify inequities in symptom management that need to be addressed at a system level. To determine whether symptoms in PBT patients vary across demographic groups, we conducted a retrospective chart review of symptom burden collected as part of routine care in a diverse population. Patient demographics and scores on the MD Anderson Symptom Inventory-Brain Tumor (MDASI-BT) module were extracted from the electronic medical record for patients seen in the Inova Neuro-oncology Clinic between March 2021 and June 2022. MDASI-BT scores were compared based on side of tumor, sex, race, and ethnicity for the entire population and for the subset with gliomas. We included 125 people, of whom 85 had gliomas. For both the entire group and the subgroup with gliomas, about 40% were female and about 40% were non-White race. No differences in symptom burden were seen between males and females. Pain and numbness/tingling symptom burden were higher in both the entire population and the glioma subgroup for people of Hispanic/Latino/Spanish ethnicity and for people of races other than White or Middle Eastern self-identification. Pain, weakness, and numbness/tingling varied significantly across racial and ethnic groups. Further research is needed to validate this finding in other populations and determine its cause.

Association Between Community Distress and Return to Work After Burn Injury

IntroductionCommunity-level disadvantage is associated with reduced quality of life after burn injury. We evaluated the association between community-level disadvantage and return to work after burn injury. MethodsA multicenter burn injury database was queried from 1998-2021. Participants 18-65 years old with documented employment status and ZIP codes were included. Exposures were community distress (Distressed Communities Index, DCI), patient demographics, and burn characteristics. The primary outcome was odds of employment 6 months after burn injury using stepwise logistic regression models, first with patient-level variables, then DCI. An interaction term was included to evaluate the modification of DCI and post-injury employment by race. Results1,960 participants were included, with a median age of 39.2 years (IQR 29.2, 49.3); 81% were White, 75% male, and 74% were working at the time of injury. Participants unemployed 6 months post-injury were more often older, female, non-White, and unemployed at injury, with larger burn sizes and longer hospitalizations. 59% of participants unemployed at 6 months were employed at the time of injury. Residence in the highest distress ZIP codes was associated with 2.21 (95% CI 1.39-3.52) odds of 6 month unemployment. Older age, larger burn size, more operations, Black race, and pre-injury unemployment were associated with the greatest odds of unemployment. The interaction between race and DCI was not statistically significant. ConclusionPatients from the highest distress communities have twice the odds of unemployment 6 months after injury. This association did not vary by race. Screening for DCI by ZIP code may be a useful tool to focus vocational rehabilitation resources.

Assessing Correlations and Demographic Interactions Between PROMIS25 and SRS30 in Pediatric Patients With Spinal Deformity.

Historically, patient-reported outcome measures (PROMs) have been measured using anatomy-specific instruments. However, these instruments may be influenced by the presence of concomitant illnesses not associated with the orthopaedic condition. As such, standardized PROM tool, such as PROMIS25, have been developed to assess patient outcomes. In this study, we aim to compare the correlation and association between 2 common PROMs used for pediatric patients with spinal deformity. This study included patients younger than 21 years who were indicated for spinal deformity surgery at our institution. All patients were invited to complete SRS-30 and PROMIS-25 instruments through an automated, electronic patient-reported outcome platform before surgery. Patient demographics were recorded and Spearman correlations were calculated between the various PROMIS and SRS domains. Correlations were compared between different baseline characteristics and demographics using a rho-to-z transformation method. Ceiling and floor effects were also investigated. A total of 207 patients were enrolled in this study. The majority of PROMIS and SRS domains had moderate to strong correlations, with higher correlations observed when each instrument tried to capture the same construct. For example, there was strong correlation between PROMIS raw pain and SRS pain (ρ=-0.86, P <0.01), and PROMIS Depression and SRS Mental Health (ρ=-0.76, P <0.01). Ceiling effects ranged from 1.0 to 16.9% in SRS and 0.5 to 28.5% is PROMIS. Floor effects ranged from 0.5 to 1.5% in SRS and 0.5 to 29.0% in PROMIS. There were significant differences in the correlation between SRS Mental Health and PROMIS Depression when comparing between different sexes (male: ρ=-0.74, female: ρ=-0.59, P =0.04). In addition, there were significant differences in the correlation between SRS Mental Health and PROMIS Anxiety when comparing between different insurance payors (commercial: ρ=-0.86, female: ρ=-0.75, P =0.03). There is strong correlation between SRS and PROMIS domains in pediatric patients with spinal deformity. These correlations can differ by baseline characteristics and demographics. Providers should consider these differences when interpreting PROMs in diverse patient populations. Level III; Retrospective comparative study.

Standardized Wound Care: Patchwork Practices?

Standardized care is crucial in health care for ensuring consistent, safe, high-quality, efficient, and evidence-based practices. Care pathways that standardize procedures promote adherence to best practices, reduce variability in treatment, and encourage collaboration among health care teams. This approach ultimately improves patient outcomes, enhances safety, and boosts the overall effectiveness of health care services. However, despite these benefits being widespread across most of the U.S. health care system, wound care stands out as an area where standards can vary significantly. The inconsistency in wound care standards in the United States can be traced to several factors. These include limited structured clinical wound care education, the discretion of health care providers in different business environments, differences in wound care settings, varying access to advanced treatments and technology, patient demographics and socioeconomic status, as well as differences in state laws and regional or institutional practices. Addressing these disparities requires a comprehensive approach that considers the complex interplay of the abovementioned factors. Active measures are needed to improve access, equity, and the quality of wound care services for all patients, regardless of where they live, their socioeconomic status, their health care coverage, or the business interests of providers and their institutions as well as of vendors marketing wound care products inconsistent with evidence-based practice. By understanding and actively addressing these factors, we can work toward achieving more standardized, evidence-based, and patient-centered practices in wound care across the nation.