Orthopedic Surgery Patients Research Articles

Deciphering the Frailty Factor: Comprehensive Insights Into Its Impact on Postoperative Complications and Recovery Among Elderly Orthopedic Surgery Patients

Deciphering the Frailty Factor: Comprehensive Insights Into Its Impact on Postoperative Complications and Recovery Among Elderly Orthopedic Surgery Patients

Anticholinergic Exposure, Drug Dose and Postoperative Delirium: Comparison of Dose-Related and Non-Dose-Related Anticholinergic Burden Scores in a Retrospective Cohort Study of Older Orthopaedic and Trauma Surgery Patients.

Postoperative delirium (POD) is a common complication in older adult patients after surgery. A patient's preoperative anticholinergic (AC) burden is a potentially modifiable risk factor for POD. As the influence of the drug dose remains unknown, we aimed to compare three AC burden scores in relation to POD, two of which were dose-related. This retrospective cohort study (03/22-10/22) included orthopaedic and trauma surgery patients > 65 years. POD was assessed using the four A's test (4AT), delirium diagnosis, and chart review. The AC burden was determined using the non-dose-related German Anticholinergic Burden score (GerACB), an extension of the dose-related Muscarinic Acetylcholinergic Receptor ANTagonist Exposure scale (extMARANTE), and the dose-related German Drug Burden Index (GerDBI). Multivariable logistic regression analysis determined the association between the preoperative AC burden and POD. Scores were compared using kappa statistics, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). POD was observed in 71 of 385 patients (18.4%). For all three scores, a high AC burden was significantly associated with POD after adjusting for age, sex, dementia, preoperative physical status, and number of prescribed drugs (p < 0.001). The overall agreement among the burden classifications was substantial (no POD: κ = 0.645, POD: κ = 0.632). The GerACB had the lowest sensitivity with 23.9% (extMARANTE: 42.3%, GerDBI: 40.8%), but the highest PPV with 48.6% (extMARANTE: 38.5%, GerDBI: 43.3%). Both dose-related and non-dose-related AC burden scores have limited sensitivity and modest PPV for screening a patient's medication for POD. However, given the additional effort required for dose consideration, the non-dose-related GerACB remains sufficient in clinical practice, with the lowest sensitivity but highest PPV.

Doctor, when can Idrive? Characterization of driving behavior of orthopedic and trauma surgery patients using aprospective questionnaire study

Individual mobility in road traffic is of high importance in Germany, both individually and socioeconomically; however, diseases and injuries of the musculoskeletal system in particular can lead to temporary impairments. The aim of this prospective patient survey was to record how patients assessed their driving capability during an injury and the associated immobilization and on what basis the decision on driving capability was made on the part of the patients. Asystematic questionnaire was used to analyze atotal of 100 patients with a diagnosis in orthopedics/trauma surgery and associated joint immobilization. In addition to personal data and the injuries/illnesses, an analysis on risk tolerance was performed and patients were asked about their knowledge regarding driving capability. Finally, it was recorded which patients drove amotor vehicle and for what reasons despite immobilization. Overall, 40.2% reported knowledge of the applicable laws regarding driving capability and 55.6% considered the treating physician to be responsible regarding the decision on driving capability. The patients who drove amotor vehicle reported higher personal and professional dependence on the motor vehicle (personal: 60.6% vs. 45.7%; professional: 48.5% vs. 36.1%). In the group of patients who drove amotor vehicle during immobilization, overall afracture was less likely to be the reason for immobilization (33.3% vs. 51.0%). Overall, the patient population rated their knowledge of the law as low and viewed the treating physician as having the majority of the decision-making responsibility regarding driving capability. The patients who drove amotor vehicle during immobilization reported ahigher personal as well as professional dependence on driving amotor vehicle. At the same time the injury severity had an influence on the decision, so that patients with fractures were more likely to avoid driving amotor vehicle. Further studies, particularly at the biomechanical level, are needed to ensure abetter basis for the physician in making decisions with respect to the driving capability of orthopedic and trauma surgery patients.

The relationship between fragility scores and intraoperative body temperature changes in geriatric patients: Prospective observational research.

Today, to evaluate morbidity and mortality in elderly surgical patients, fragility scores, which reflect the patient's current condition rather than increasing age, are used as a basis. Our research examines the association between fragility groups, body temperature changes, and inadvertent perioperative hypothermia (IPH) in major orthopedic surgery patients. Patients over the age of 65 who underwent major orthopedic surgery were evaluated. Body temperature measurements were taken tympanically preoperatively and every 5 minutes during surgery. Temperature changes (Δn) were calculated. Patients whose body temperature was below 36 °C were recorded as IPH. The Canadian Study of Health and Aging-Clinical Frailty Scale scoring system, consisting of 9 categories, was used for fragility scores. As the category number increases, the level of fragility increases. These categories are classified into 3 subgroups: Group F1 (Level 1-3), Group F2 (Level 4-7), and Group F3 (Level 8-9). Age groups: it is defined as Group A1 (66-74 years), Group A2 (75-84 years), and Group A3 (85<). The median (min-max) of surgery time was determined as 75 (35-131). For Δ35 (ºC), the differences between both fragility groups (P = .054) and the age groups (P = .145) were not significant. IPH frequency is 44.0% (n = 149). No difference was detected between hypothermia frequencies in the fragility groups (P = .546) and the age groups (P = .065). Nearly half of major surgery patients developed IPH. We did not find a relationship between both fragility groups and age groups and the frequency of IPH.

Angiotensin II receptor blockers and their applications in orthopaedic surgery and musculoskeletal medicine.

Angiotensin II receptor blockers (ARBs) are commonly prescribed for hypertension and heart failure, and have well-described antifibrotic properties throughout medical literature. The etiology and pathogenesis of fibrosis is biologically complex with a multitude of factors playing a role in the process. Consequently, pathologic fibrosis may be significant within orthopaedics contributing to post-operative stiffness and, ultimately, negative patient outcomes. The pharmacology of ARBs has been described to combat fibrosis in preclinical settings, while the literature of ARBs antifibrotic properties in relation to orthopaedics remains scarce. However, fibrosis is one of the primary factors contributing to tissue healing and functional recovery in the field of orthopaedic surgery. Fibrosis has specifically been described in relation to shoulder surgery, knee arthroplasty and hip arthroscopy. As such, outcomes of various orthopaedic surgeries are dependent upon a balance between tissue healing and stiffness, both of which may be mediated by a fibrotic response. Importantly, ARBs have recently emerged as a potential therapy to combat fibrosis-mediated stiffness in orthopaedic surgery patients. Thus, the following review article seeks to highlight the basic and clinical science of ARBs with emphasis on their implications and indications for orthopaedic surgery and musculoskeletal medicine.

Feasibility, Safety, and Efficacy of Segmental Spinal Anesthesia with Predominantly Isobaric Levobupivacaine: A Tertiary Care Hospital Study

Objective: To assess feasibility, safety, and efficacy of segmental spinal anesthesia with isobaric levobupivacaine in patients undergoing various abdominal and lower limb surgeries. Methods: This was a prospective cohort study conducted at the department of anesthesiology and critical care of Kota heart institute and group of hospitals in India. The study involved 100 patients undergoing various abdominal and lower limb surgeries under segmental spinal anesthesia (SSA). Isobaric levobupivacaine 0.5% with fentanyl 20-25 μg or dexmedetomidine 5-10 as adjuvant or hypobaric levobupivacaine 0.167% was injected in intervertebral space depending on the surgery. Hemodynamic parameters, postoperative pain level, and adverse effects were analyzed with a p-value less than 0.05 was considered statistically significant.Results: An overall male predominance was observed with a 1:0.515 male-to-female ratio. The most affected age group was 41-50 years (37%), with a mean age of 44.51 ± 11.72 years. ASA classification indicated 34% of patients in ASA I, 40% in ASA II, 24% ASA III and 2% in ASA IV . The primary surgery was laparoscopic cholecystectomy (26%) in normal risk group and orthopedic in high-risk group(20%). Postoperative pain assessment showed mean VAS scores ranging from 1.92 to 3.42 at different time intervals. Common adverse effects were hemodynamic instability (13%), shoulder tip pain (33%), PONV (3%), headache (6%), pruritis (2%) and urinary retention (1%). The hemodynamic instability showed less incidence in ASA III/IV category.Conclusion: Segmental spinal anesthesia can be used successfully for abdominal and lower limb orthopedic surgeries in patients of ASA I to ASA IV.

Vaping and Orthopedic Surgery: Perioperative Management

The growing use of electronic cigarettes (ECs) as a perceived safer alternative to traditional combustible smoking has significant implications for orthopedic surgery patients. Surgeons need to recognize the harms and risks associated with ECs beyond their nicotine content. EC aerosols contain cytotoxic elements, including harmful chemicals, carcinogens, heavy metals, and flavoring agents. They can induce oxidative stress, resulting from an imbalance between cell antioxidant defense and reactive oxygen species (ROS). These effects can compromise bone repair, particularly with skeletal system disorders. Furthermore, ECs’ impact on wound healing and surgical site infection (SSI) have been well-documented. Smoking can reduce the inflammatory healing response, impair oxidative bacterial killing mechanisms, delay the proliferation healing response, and alter collagen metabolism. Some surgical practices remain unchanged despite physicians’ efforts to inquire about EC use. Most orthopedic surgeons do not delay surgery due to nicotine consumption, and urine tests for nicotine are rarely used. However, preoperative smoking cessation interventions offer a unique opportunity to help patients stop consuming nicotine. Therefore, it is crucial for orthopedic surgeons to understand the harms of ECs and communicate the associated risks to patients.

Psoas muscle cross sectional area relates to bone density and microarchitecture in candidates for spine fusion surgery

Prior studies demonstrate that muscle and bone health are integrally related, and both independently impact orthopedic surgery outcomes. However, relationships between bone density, in vivo microarchitecture, and muscle area have not been previously investigated in orthopedic surgery patients. This study assessed associations between psoas cross sectional area (CSA), bone mineral density (BMD), and microstructure in a cohort undergoing spine fusion. Pre-operatively, bilateral psoas CSA was measured on axial lumbar spine CT in the L3-L4 disc space. To adjust for body size, Psoas Muscle Index (PMI) was calculated (CSA divided by the square of patient height). High resolution peripheral quantitative CT (HR-pQCT, XtremeCT2) assessed volumetric BMD (vBMD), cortical (Ct) and trabecular (Tb) microarchitecture at the distal radius and tibia. Areal BMD (aBMD) was measured by DXA at the lumbar spine (LS), total hip (TH), femoral neck (FN), and the 1/3 radius (1/3R). Pearson correlations related psoas CSA and bone imaging parameters before and after correcting for height and weight. Among 88 patients included, mean age was 63 ± 12 years, BMI was 28 ± 7 kg/m2, 47 (53 %) were female. Larger psoas CSA was associated with higher vBMD, greater Ct thickness and better Tb microarchitecture (higher Tb number and lower Tb separation) at the tibia and radius. Larger psoas CSA was also associated with greater aBMD at TH and FN bilaterally and 1/3R (r 0.33 to 0.61; p < 0.002 for all comparisons). Psoas CSA was not associated with aBMD at the LS. Similar results were observed when relating PMI, and adjusting for age, height and weight to HR-pQCT and DXA measurements. Investigation of subgroups by sex demonstrated that relationships were similar magnitude among women but not the men. Patients who underwent primary compared to revision spine surgery had similar associations. Our results demonstrate a link between psoas muscle size and peripheral bone microarchitecture among patients undergoing posterior lumbar spinal fusion. Given the importance of both muscle and skeletal integrity to the success of spine surgery, further study regarding the associations between measurements of psoas muscle, bone microarchitecture, and surgical outcomes is warranted.

Electrolyte Disturbances and Repletion in Orthopaedic and Spine Surgery Patients.

Electrolyte derangement, defined as disorders of clinically impactful physiologic ions such as potassium, sodium, calcium, magnesium, and phosphate, has a variety of clinical manifestations. These electrolytes have narrow windows of normal in vivo concentration before neurologic, cardiac, renal, or gastrointestinal consequences occur. Perioperative disturbances in electrolyte concentration can lead to increased morbidity and mortality, longer length of stay, and higher rates of short and medium-term readmission in orthopaedic and spine surgery postoperatively. To prevent electrolyte related complications, careful monitoring and repletion of at-risk patients must be undertaken. A systematic approach to repletion allows for a safe and efficacious treatment of these disorders.

Preoperative and Postoperative Therapeutic Anticoagulation in Orthopaedic Surgery Increases the Risk of Bleeding: A Systematic Review and Meta-Analysis.

Patients requiring postoperative therapeutic anticoagulation may have increased risk of bleeding complications, infection, and poor wound healing. The purpose of this study was to perform a systematic review and meta-analysis assessing bleeding complication rates among orthopaedic surgery patients receiving perioperative therapeutic anticoagulation. A systematic review and meta-analysis was performed in concordance with the Preferred Reporting Items for Systematic Review and Meta Analysis 2020 guidelines. PubMed was queried for articles related to therapeutic anticoagulation in orthopaedic surgery and complications using keywords and medical subject headings. Inclusion/exclusion criteria were any study reporting bleeding complications after orthopaedic surgery among patients on perioperative therapeutic anticoagulation with a minimum 1-year follow-up. Studies were reviewed for heterogeneity and risk of bias. Pooled analysis was done to determine postoperative complication rates among patients on therapeutic anticoagulation. Thirty-seven studies with 3,990 patients were included. Studies were grouped by their surgical subspecialty with 16 from arthroplasty, one foot and ankle, two spine, one sports, 13 trauma, and four upper extremity. Among patients on therapeutic anticoagulation, the pooled rate and 95% confidence intervals of bleeding complications was 8% (5 to 11%) overall, 10% (5 to 15%) in arthroplasty, 6% (3 to 11%) in trauma, and 5% (1 to 30%) in upper extremity. The overall rates (95% CI) of venous thromboembolism (VTE) were 2% (2 to 4%), infection 5% (3 to 10%), and revision surgery 4% (3 to 6%). Upper extremity VTE rates were 0% (0 to 15%), infection 4% (3 to 6%), and revision surgery 4% (3 to 6%). Trauma VTE rates were 4% (2 to 5%), infection 2% (1 to 6%), and revision surgery 3% (2 to 4%). Arthroplasty VTE rates were 2% (1 to 5%), infection 9% (4 to 18%), and revision surgery 4% (2 to 7%). Therapeutic postoperative anticoagulation may increase the risk of bleeding complications when compared with the general population. Incidence of VTE was similar when compared with historical data.

Analyzing Risk Factors for Delayed Extubation Following Posterior Approach Surgery for Congenital Scoliosis: A Retrospective Cohort Study.

Retrospective cohort study. Investigate the risk factors for delayed extubation after posterior approach orthopedic surgery in patients with congenital scoliosis. The clinical data of patients who received surgery for congenital scoliosis at the First Affiliated Hospital of Xinjiang Medical University between January 2021 and July 2023 have been gathered. Patients are categorized into the usual and the delayed extubation groups, depending on the duration of tracheal intubation after surgery. The study employs univariate and multivariate logistic regression models to examine the clinical characteristics of the two cohorts and discover potential risk factors linked to delayed extubation. In addition, a prediction model is created to visually depict the significance of each risk factor in terms of weight according to the nomogram. A total of 119 patients (74.8% females), with a median age of 15 years, are included. A total of 32 patients, accounting for 26.9% of the sample, encountered delayed extubation. Additionally, 13 patients (10.9%) suffered perioperative complications, with pneumonia being the most prevalent. The multivariate regression analysis revealed that the number of osteotomy segments, postoperative hematocrit, postoperative Interleukin-6 levels, and weight are predictive risk factors for delayed extubation. Postoperative hematocrit and Interleukin-6 level, weight, and number of osteotomy segments can serve as independent risk factors for predicting delayed extubation, with combined value to assist clinicians in evaluating the risk of delayed extubation of postoperative congenital scoliosis patients, improving the success rate of extubation, and reducing postoperative treatment time in the intensive care unit.

Psychological intervention based on cognitive behavioral therapy for patients with orthopedic surgical anxiety.

To develop a set of cognitive behavioral therapies (CBTs) to alleviate anxiety in orthopedic surgery (OS) patients, to explore the intervention effects of CBTs on the indicators of anxiety, sleep quality, and pain sensation in OS patients, and to promote them. A total of 68 qualified subjects were selected from among the 103 patients with orthopedic diseases who were hospitalized in the orthopedic department of the hospital between June 2022 and November 2023. According to the different nursing methods, they were divided into a psychological intervention (PI) group and a control intervention group. Among them, 34 patients received hospital-developed CBT for OS in the PI group, and 34 patients received standard orders from the medical staff in the control intervention group. Tools such as self-assessment of anxiety, Athens insomnia scale, state anxiety scale, visual analog pain method, and self-management level scale were utilized to assess the change in anxiety levels, sleep quality, pain perception, and self-management level of the 2 groups of patients before and after the surgery. Following the CBT intervention, patients in the PI group had significantly lower Athens insomnia scale (5.32 ± 0.42), state anxiety scale (38.21 ± 1.12), and visual analog pain method (3.93 ± 1.24) scores than those in the control intervention group. This difference was statistically significant (P < .05). In the meantime, patients in the PI group had a substantially higher correct rate of illness cognition assessment (98.21%) than patients in the control intervention group (65.12%), and this difference was statistically significant (P < .05). The study collated the factors affecting anxiety in OS patients through questionnaire survey and statistical analysis experiment and then formulated a detailed CBT strategy for specific problems. Finally, CBT is a valuable tool for reducing anxiety in OS patients. As such, it deserves to be promoted and used in clinical settings.

Area Deprivation Index as a proxy for socioeconomic status in outpatient orthopaedic surgery patients – A prospective registry cross sectional study

BackgroundWe aimed to determine if Area Deprivation Index (ADI) is associated with self-reported metrics socioeconomic status (SES), and to assess the relationship between ADI and preoperative score on common patient reported outcome scores (PROS). MethodsPatients presenting for outpatient orthopaedic surgery completed Patient-Reported Outcome Metric Information System (PROMIS) and joint-specific PROS. ADI was determined from geocoded home address. Sociodemographic data was collected from self-reported survey. Tests of association were used to describe the relationship between ADI and sociodemographic factors as well as the correlation between ADI and PROS. Extreme group analysis was used to examine which PROS may be subject to clinically meaningful variation. ResultsADI was associated with self-reported SES. ADI was correlated with score on all baseline PROS. Extreme group analysis showed that low SES was associated with clinically meaningful differences in some, but not all, PROS. ConclusionADI is associated with self-reported measures of SES in an orthopaedic outpatient surgical population. Lower SES correlates with worse function to a clinically significant degree for some PROS. SES should be considered in the context of preoperative symptom severity in outpatient orthopaedic surgery patients. ADI may be a useful adjunct to self-reported measures of SES for this purpose.

The Lack of Reporting Social Determinants of Health in Pediatric Orthopaedic Randomized Controlled Trials.

Social determinants of health (SDOHs) affect health outcomes outside the hospital, and understanding them can enhance postoperative outcomes in orthopaedic surgery patients. This study aimed to describe the prevalence of randomized controlled trials (RCTs) in pediatric orthopaedic journals reporting on the SDOHs of their patient cohorts. We hypothesize that many SDOHs will be underreported in RCTs investigating pediatric orthopaedic surgery. Utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, the authors queried the PubMed database to examine SDOHs from 2 pediatric orthopaedic journals: Journal of Pediatric Orthopaedics and Journal of Pediatric Orthopaedics: Part B. The inclusion criteria incorporated RCTs published between 2005 and April 2024. The exclusion criteria included any articles that were not RCTs published in this period. One hundred thirteen articles met the search criteria, with 31 excluded because they did not fall from 2005 to 2024. Eighty-two were published from 2005 to 2024, but 6 RCTs were excluded, as 3 were non-RCTs, and 3 examined cadavers. Seventy-six RCTs were included for analysis, with 65 articles from the Journal of Pediatric Orthopaedics and 11 articles from the Journal of Pediatric Orthopaedics: Part B. Articles originated from 17 countries, with the United States producing 61.8% (47) of the included studies. Of all 76 included studies, 96.1% (73) reported age, 88.2% (67) reported sex/gender, 30.3% (23) reported BMI, 21.1% (16) reported race/ethnicity, 5.3% (4) reported educational level, 2.6% (2) reported stress, and 2.6% (2) reported insurance. Smoking status, socioeconomic status, income levels, and employment status were each reported by only 1 study. The RCTs examining pediatric orthopaedic surgery tend to scarcely report SDOHs. Future RCTs should expand beyond demographic characteristics such as age, race/ethnicity, sex/gender, and BMI and incorporate other relevant SDOHs. This will allow us to develop a more comprehensive understanding of health outcomes in the pediatric orthopaedic population. I; Therapeutic Studies.

Exploring the Potential of a Smart Ring to Predict Postoperative Pain Outcomes in Orthopedic Surgery Patients.

Poor pain alleviation remains a problem following orthopedic surgery, leading to prolonged recovery time, increased morbidity, and prolonged opioid use after hospitalization. Wearable device data, collected during postsurgical recovery, may help ameliorate poor pain alleviation because a patient's physiological state during the recovery process may be inferred from sensor data. In this study, we collected smart ring data from 37 inpatients following orthopedic surgery and developed machine learning models to predict if a patient had postsurgical poor pain alleviation. Machine learning models based on the smart ring data were able to predict if a patient had poor pain alleviation during their hospital stay with an accuracy of 70.0%, an F1-score of 0.769, and an area under the receiver operating characteristics curve of 0.762 on an independent test dataset. These values were similar to performance metrics from existing models that rely on static, preoperative patient factors. Our results provide preliminary evidence that wearable device data may help control pain after orthopedic surgery by incorporating real-time, objective estimates of a patient's pain during recovery.

The Perception and Use of Dexmedetomidine Among Anesthesia Providers: A Quality Improvement Project

PurposeIntraoperative opioid use is associated with postoperative nausea and vomiting, respiratory depression, and persistent postoperative pain, all of which contribute to increased length of stay and health care costs. Although research shows adding dexmedetomidine as an adjunct leads to reduced opioid-related postoperative complications, many anesthesia providers are not using this medication. The purpose of this quality improvement project was to increase the use of dexmedetomidine among anesthesia providers to improve outcomes among spinal and orthopedic surgery patients. DesignQuality improvement study. MethodsThe project consisted of a preimplementation retrospective chart review, a preimplementation staff survey, the implementation of an anesthesia training bundle, a postimplementation staff survey, and a postimplementation retrospective chart review. The team provided ongoing support for the use of dexmedetomidine with resource flyers, a recorded presentation, and provider support. FindingsPreimplementation surveys indicated staff readiness for change and identified the lack of availability of dexmedetomidine within the operating rooms as the barrier to use. After receiving education, staff requested dexmedetomidine to be stocked within every operating room. Utilization increased by 67% after the implementation of the anesthesia training bundle. ConclusionsWhile there was no significant change in opioid-related complications as is found in the literature, the project education and support led to anesthesia provider interest in using dexmedetomidine, resulting in a significant increase in use. Similar projects should include education for postanesthesia care nurses.

Effect of Red Blood Cell Transfusion on Central Venous-to-Arterial Carbon Dioxide Difference in Anemic Surgical Patients – A Pilot Study

Background: Biochemical markers for monitoring adequacy of cardiac output and tissue perfusion such as blood lactate and central venous oxygen saturation (ScvO2) are meanwhile well established in clinical routine. In addition, in recent years, the central venous-to-arterial carbon dioxide difference (dCO2) has been evaluated as a further marker, and studies meanwhile have demonstrated the validity of an increased dCO2 to identify capillary perfusion mismatches. However, results from animal studies suggest that dCO2 may be influenced by altered hemoglobin values during severe bleeding. It was the aim of our study to evaluate if dCO2 changes upon Red Blood Cell (RBC) transfusion in humans. Methods: Patients of the ongoing LIBERAL trial were prospectively evaluated. Participants were aged ≥70 years and scheduled for elective intermediate or high risk orthopedic or trauma surgery with the clinical need for invasive blood pressure monitoring and central venous catheterization. During surgery, drop of hemoglobin triggered administration of one single RBC unit, together with arterial and central venous blood analysis immediately before as well as after transfusion. Results: In total, 46 patients were analyzed. Baseline median hemoglobin before RBC transfusion was 8.35 (7.48–8.73)g/dl, while dCO2 was 6.2 (3.4–9.6)mmHg. According to Spearman correlation, there was a linear association between pre-transfusion dCO2 and ScvO2. Transfusion of one RBC unit resulted in a significant increase of median hemoglobin by 1.2 (0.7–1.63)g/dl (p&lt;0.0001), and hemoglobin increase was more pronounced when pre-transfusion hemoglobin was low, as evidenced by a significant negative association between both parameters (r=-0.61, p &lt;0.0001). Neither lactate nor ScvO2 nor dCO2 were significantly influenced by transfusion. When the whole cohort was divided according to pre-transfusion dCO2 levels using a cut-off value of 6 mmHg, median dCO2 decreased significantly more pronounced following RBC transfusion when pre-transfusion values were high (&gt;6 mmHg), compared to those patients with a pre-transfusion dCO2 below 6 mmHg. Conclusions: The results of our study suggest that crude dCO2 is not influenced by moderate hemoglobin increases in orthopedic and trauma surgery patients. However, including dCO2 into the decision whether to administer RBC or not may be an interesting reasonable approach for further investigations on the way towards more individualized transfusion regimens.

Racial Disparities Exist in 90-Day Unplanned Return to the Emergency Department Following Orthopaedic Trauma Surgery.

Racial disparities in healthcare outcomes exist, including in orthopaedic trauma care. The aim of this study was to determine the impact of race, social deprivation, and payor status on 90-day emergency department (ED) revisits among orthopaedic trauma surgery patients at a Level 1 trauma academic medical center. Retrospective chart review analysis. Level 1 trauma academic center in Durham, NC. Adult patients undergoing orthopaedic trauma surgery between 2017 and 2021. The primary outcome of this retrospective cohort study was 90-day return to the ED. Logistic regression analysis was performed for variables of interest [race, social deprivation (measured by the Area Deprivation Index), and payor status] separately and combined, with each model adjusting for distance to the hospital. Results were interpreted as odds ratios (ORs) of 90-day ED revisits comparing levels of the respective variables. Statistical significance was assessed at α = 0.05. A total of 3120 adult patients who underwent orthopaedic trauma surgery between 2017 and 2021 were included in the analysis. Black race (OR = 1.47; 95% confidence interval [CI]: 1.17-1.84, P < 0.001) and Medicaid coverage (OR = 1.63, 95% CI: 1.20-2.21, P = 0.002) were significantly associated with higher odds of return to ED compared with non-Black or non-Medicaid-covered patients. While ethnic minority (Hispanic/Latino or non-White) was statistically significant while adjusting only for distance to the hospital (OR = 1.23, 95% CI: 1.00-1.50, P = 0.047), it was no longer significant after adjusting for the other sociodemographic variables (OR = 1.13, 95% CI: 0.91-1.39, P = 0.27). The weighted Area Deprivation Index was not associated with a difference in odds of return to ED in any adjusted models. The results highlight the presence of racial and socioeconomic disparities in ED utilization, with Black race and Medicaid coverage significantly associated with higher odds of return to the ED. Future research should delve deeper into comprehending the root causes contributing to these racial and socioeconomic utilization disparities and evaluate the effectiveness of targeted interventions to reduce them. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Poster 371: ChatGPT: An Effective Tool for Patients to Understand Platelet-Rich Plasma in Orthopedic Surgery

Objectives: Web-based technology has augmented healthcare delivery for both patients and providers. ChatGPT, a free and easily accessible artificial intelligence (AI) chatbot, has the potential to further optimize current practice. The chatbot has cemented itself as an informative resource for orthopaedic patients, but its use in ortho-biologics, particularly platelet-rich plasma (PRP), has not been described. The purpose of this study was to assess the quality of information provided by ChatGPT in response to frequently asked questions about the use of PRP in orthopedic surgery. Methods: ChatGPT was posed 10 frequently asked questions about the use of PRP in orthopedic surgery in a conversational thread. Responses were recorded and no follow-up queries or clarification was obtained. The responses were subsequently graded “A,” “B,” “C,” or “F,” corresponding with “excellent response,” “adequate response needing mild clarification,” “inadequate response needing moderate clarification,” and “poor response needing severe clarification.” Results: Of the 10 responses, 1 was grade “A,” 7 were grade “B,” 2 were grade “C,” and 0 were grade “F.” Overall, ChatGPT provided good quality responses to the prompts. Conclusions: ChatGPT provided sufficient responses to questions regarding PRP in orthopedic surgery, utilizing appropriate language to provide responses representative of the current literature surrounding PRP. The biggest limitation to superior chatbot performance is the lack of robust consensus on the use and preparation of PRP. This study accentuated the possibility for ChatGPT to serve as an additional informative resource for orthopedic surgery patients who want to learn about PRP.

The Relevance of Implanted Percutaneous Electrical Nerve Stimulation in Orthopedics Surgery: A Systematic Review.

Background: Percutaneous peripheral nerve stimulation (PNS) is a form of neuromodulation that involves the transmission of electrical energy via metal contacts known as leads or electrodes. PNS has gained popularity in orthopedic surgery as several studies have supported its use as a pain control device for patients suffering from pain due to orthopedic pathologies involving the knee, shoulder, and foot. The purpose of this systematic review is to summarize the literature involving peripheral nerve stimulation in orthopedic surgery. The existing body of literature provides support for further research regarding the use of PNS in the management of knee pain, hip pain, shoulder pain, foot pain, and orthopedic trauma. Notably, the evidence for its efficacy in addressing knee and shoulder pain is present. Methods: This study was conducted following PRISMA guidelines. Seven hundred and forty-five unique entries were identified. Two blinded reviewers assessed each article by title and abstract to determine its relevance and categorized them as "include", "exclude", and "maybe". After a preliminary review was completed, reviewers were unblinded and a third reviewer retrieved articles labeled as "maybe" and those with conflicting labels to determine their relevance. Twenty-eight articles were included, and seven hundred and seventeen articles were excluded. Articles discussing the use of PNS in the field of orthopedic surgery in patients > 18 years of age after 2010 were included. Exclusion criteria included neuropathic pain, phantom limb pain, amputation, non-musculoskeletal related pathology, non-orthopedic surgery related pathology, spinal cord stimulator, no reported outcomes, review articles, abstracts only, non-human subjects. Results: A total of 16 studies analyzing 69 patients were included. All studies were either case series or case reports. Most articles involved the application of PNS in the knee (8) and shoulder (6) joint. Few articles discussed its application in the foot and orthopedic trauma. All studies demonstrated that PNS was effective in reducing pain. Discussion: Peripheral nerve stimulation can be effective in managing postoperative or chronic pain in patients suffering from orthopedic pathology. This systematic review is limited by the scarcity of robust studies with substantial sample sizes and extended follow up periods in the existing literature.