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Article: An Evaluation of Patient-reported Outcome Measures and Minimal Clinically Important Difference Usage in Hand Surgery.

Nielsen, Colby / Merrell, Dallin / Reichenbach, Rachel / Mayolo, Patrick / Qubain, Leeann / Hustedt, Joshua W

Plastic and reconstructive surgery. Global open

2023 Volume 11, Issue 12, Page(s) e5490

Abstract: Background: This study was designed to examine the current use of patient-reported outcome measures (PROMs) and minimal clinically important difference (MCID) calculations in the hand surgery literature in an effort to standardize their use for research ...

Abstract	Background: This study was designed to examine the current use of patient-reported outcome measures (PROMs) and minimal clinically important difference (MCID) calculations in the hand surgery literature in an effort to standardize their use for research purposes. Methods: A systematic review of the hand surgery literature was conducted. All nonshoulder upper extremity articles utilizing PROMs were compared between different journals, different surgical indications, and differing usage. MCID values were reported, and calculation methods assessed. Results: In total, 4677 articles were reviewed, and 410 met the inclusion criteria of containing at least one PROM. Of the 410 articles reporting PROMs, 148 also mentioned an associated MCID. Of the articles that mentioned MCIDs, 14 calculated MCID values based on their specific clinical populations, whereas the remainder referenced prior studies. An estimated 35 different PROMs were reported in the study period; 95 different MCID values were referenced from 65 unique articles. Conclusions: There are many different PROMs currently being used in hand surgery clinical reports. The reported MCIDs from their related PROMs are from multiple different sources and calculated by different methods. The lack of standardization in the hand surgery literature makes interpretation of studies utilizing PROMs difficult. There is a need for a standardized method of calculating MCID values and applying these values to established PROMs for nonshoulder upper extremity conditions.
Language	English
Publishing date	2023-12-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2851682-5
ISSN	2169-7574 ; 2169-7574
ISSN (online)	2169-7574
ISSN	2169-7574
DOI	10.1097/GOX.0000000000005490
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Article ; Online: Surgical knee denervation for the treatment of pain due to primary osteoarthritis.

Hustedt, Joshua W / Reichenbach, Rachel / Merrell, Dallin / Watzig, Ben / Robainia, Joey / Silvestri, Brianna

Plastic and reconstructive surgery

2023

Abstract: Background: Denervation techniques have increased in popularity for treatment of primary knee osteoarthritis. However, few clinical trials have been conducted on surgical knee denervation. This study was conducted to evaluate the safety and efficacy of ... ...

Abstract	Background: Denervation techniques have increased in popularity for treatment of primary knee osteoarthritis. However, few clinical trials have been conducted on surgical knee denervation. This study was conducted to evaluate the safety and efficacy of a surgical denervation technique for the treatment of primary knee osteoarthritis. Methods: Patients were included in the trial if they had failed conservative management for osteoarthritis with corticosteroid injections and were not candidates for total knee arthroplasty. Patients were treated with a surgical knee denervation. Pre- and post-operative scores were assessed to examine the improvement in pain, function, and quality of life. Results: Twenty-four knee denervation procedures were performed in twenty-one patients. The average follow-up time was 21 months, with a minimum follow up of 12 months. Patients experienced an improvement in pain with a decrease in VAS pain scores from 8.7 to 2.9, an improvement in function with a decrease in WOMAC scores from 69 to 32, and an improvement in quality of life with an increase in EQ-5D from 0.183 to 0.646. A clinically significant improvement in pain occurred in 92% patients, while 75% of patients had an improvement in function, and 83% an improvement in quality of life. Conclusions: The treatment of recalcitrant knee pain in non-arthroplasty candidates is a difficult issue. This trial suggests that a surgical denervation technique provides improvement in pain, function, and quality of life. Surgical denervation may be a beneficial treatment for patients with recalcitrant pain from primary knee osteoarthritis.
Language	English
Publishing date	2023-09-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	208012-6
ISSN	1529-4242 ; 0032-1052 ; 0096-8501
ISSN (online)	1529-4242
ISSN	0032-1052 ; 0096-8501
DOI	10.1097/PRS.0000000000011020
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Article ; Online: The Moderating Effect of Age on Patient-Reported Benefits From Operative Management of Intra-Articular Distal Radius Fractures: A Meta-Regression Analysis.

Hustedt, Joshua W / Chartrand, Nicholas / Merrell, Dallin / Reichenbach, Rachel / Pinkston, Eric / Stecher, Chad

The Journal of hand surgery

2023 Volume 48, Issue 12, Page(s) 1193–1199

Abstract: Purpose: The optimal treatment of intra-articular distal radius fractures in older adults (>65 years) remains uncertain despite numerous randomized trials. The purpose of this study was to examine the moderating effect of age on patient-reported ... ...

Abstract	Purpose: The optimal treatment of intra-articular distal radius fractures in older adults (>65 years) remains uncertain despite numerous randomized trials. The purpose of this study was to examine the moderating effect of age on patient-reported benefits of volar locked plating versus cast immobilization for intra-articular distal radius fractures. Methods: A meta-analysis of randomized controlled trials was conducted to compare volar locked plating and cast immobilization of intra-articular distal radius fractures. Meta-regression analyses were used to examine the moderating effect of age on improvements in patient-reported outcome measures from operative treatment of distal radius factures. Modeling results were then used to estimate improvements in Disability of the Arm, Shoulder, and Hand (DASH) scores from surgery that are associated with ages ranging from 65 to 90 years. Results: Twelve randomized controlled trials including 1,806 patients were included. Age was a significant moderator of patient-reported benefits after operative treatment, with decreasing DASH score benefits from surgery associated with older ages. Model predictions show that a majority of patients aged <70 years will experience a clinically meaningful improvement in DASH scores from surgery. Patients aged 70-80 years have decreasing DASH benefits with age, but many may still experience a clinically meaningful improvement from surgery. Patients aged >80 years are unlikely to experience a clinically meaningful improvement in DASH scores with surgical management. Conclusions: Older ages are associated with decreased benefits from surgical management with volar locked plating as compared to cast immobilization. Patients aged >80 years are unlikely to experience a clinically significant improvement with surgery. Surgeons and policymakers may use these data to counsel patients, health systems, and professional organizations on the risks and benefits of operative treatment in older adults. Type of study/level of evidence: Prognosis 1, Meta-Analysis of Randomized Controlled Trials.
MeSH term(s)	Humans ; Aged ; Radius Fractures/surgery ; Wrist Fractures ; Treatment Outcome ; Bone Plates ; Fracture Fixation, Internal/methods ; Range of Motion, Articular ; Intra-Articular Fractures ; Randomized Controlled Trials as Topic
Language	English
Publishing date	2023-10-13
Publishing country	United States
Document type	Meta-Analysis ; Journal Article
ZDB-ID	605716-0
ISSN	1531-6564 ; 0363-5023
ISSN (online)	1531-6564
ISSN	0363-5023
DOI	10.1016/j.jhsa.2023.09.001
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Zs.A 1431: Show issues

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Article: Targeted Muscle Reinnervation Does Not Increase the Risk of Postsurgical Complication or Overall Cost.

Deeyor, Sorka T / Kisana, Haroon M / Hui, Clayton H / Stecher, Chad / Hustedt, Joshua W

Plastic and reconstructive surgery. Global open

2022 Volume 10, Issue 8, Page(s) e4488

Abstract: Background: Targeted muscle reinnervation (TMR) has shown promise in reducing postsurgical limb pain in amputees. However, there has been little evidence on the increased risk of complications and cost as compared with traditional amputations. This ... ...

Abstract	Background: Targeted muscle reinnervation (TMR) has shown promise in reducing postsurgical limb pain in amputees. However, there has been little evidence on the increased risk of complications and cost as compared with traditional amputations. This study was designed to assess the rate of complications and healthcare costs between those treated with TMR and traditional amputations. Methods: Patients undergoing amputation were selected from the PearlDiver Mariner dataset and categorized into one of two treatment groups depending on the use of TMR versus traditional amputation. Rates of postsurgical complications and overall healthcare costs were compared between the two groups, while controlling for differences in patient demographics and comorbidities. Results: One hundred sixteen TMR procedures and 76,412 traditional amputations were included in the study. The rate of complications did not differ between groups, with a complication rate of 77% in the TMR and 87% in the traditional amputation groups. Overall healthcare costs also did not differ 1 year after surgery, with an average cost of $32,632 in the TMR group and $36,219 in the traditional amputation group. Conclusions: Amputees experience high rates of postsurgical complications, morbidity, and mortality. However, there is no increased risk of complications or cost with the use of TMR. TMR has the potential benefits of reducing overall postsurgical pain and reestablishing activities of daily living. Although TMR is more expensive up front, it may reduce the overall healthcare costs by reducing the need for subsequent care. Further work is needed in large, randomized trials to examine these findings.
Language	English
Publishing date	2022-08-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	2851682-5
ISSN	2169-7574 ; 2169-7574
ISSN (online)	2169-7574
ISSN	2169-7574
DOI	10.1097/GOX.0000000000004488
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Zs.A 7091: Show issues

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Article ; Online: Development of a Risk Stratification Scoring System to Predict General Surgical Complications for Patients Undergoing Foot and Ankle Surgery.

Kisana, Haroon / Hui, Clayton H / Deeyor, Sorka / Martin, John R / Stecher, Chad / Hustedt, Joshua W

Orthopedics

2022 Volume 45, Issue 3, Page(s) 139–144

Abstract: Preventing postoperative complications is crucial for patients, surgeons, and health care facilities. We developed a risk stratification scoring system to optimize postoperative outcomes for patients undergoing foot and ankle surgery. A total of 35,580 ... ...

Abstract	Preventing postoperative complications is crucial for patients, surgeons, and health care facilities. We developed a risk stratification scoring system to optimize postoperative outcomes for patients undergoing foot and ankle surgery. A total of 35,580 patients who underwent foot and ankle procedures from 2005 to 2017 were identified as part of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). To assess the risk of a postoperative complication, we identified several independent risk factors associated with 30-day postoperative complications, then proceeded to develop a point-based risk scoring system. To validate our scoring system, we used it on a cohort of patients from the database who underwent foot and ankle surgery. Risk factors that correlated with postoperative complications included tobacco abuse, age (≥65 years), diabetes mellitus, hypertension, elevated creatinine level (≥1.3 mg/dL), hypoalbuminemia (<3.5 g/dL), chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), hyponatremia (<135 mEq/L), and anemia (hematocrit value, men <42%; women <38%). Point scores for each factor were: anemia, +10; hypoalbuminemia, +9; elevated creatinine level, +6; CHF, +4; diabetes mellitus, +3; hyponatremia, +3; COPD, +2; hypertension, +2; age, +1; and tobacco abuse, +1. For the validation cohort, we stratified patients according to risk as low (0-20 points), medium (21-30 points), and high (≥31 points) risk. In terms of having a postoperative complication, compared with low-risk patients, patients who were at medium risk had an odds ratio of 4.7 (95% CI, 2.8-7.9) and those at high risk had an odds ratio of 8.3 (95% CI, 4.8-14.5). [
MeSH term(s)	Aged ; Anemia ; Ankle/surgery ; Creatinine ; Female ; Humans ; Hypertension ; Hypoalbuminemia/complications ; Hyponatremia/complications ; Male ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Pulmonary Disease, Chronic Obstructive/complications ; Retrospective Studies ; Risk Assessment/methods ; Risk Factors
Chemical Substances	Creatinine (AYI8EX34EU)
Language	English
Publishing date	2022-02-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	424447-3
ISSN	1938-2367 ; 0147-7447
ISSN (online)	1938-2367
ISSN	0147-7447
DOI	10.3928/01477447-20220217-03
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Zs.A 1487: Show issues

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Article ; Online: A Prospective Clinical Trial Comparing Denervation With Suspension Arthroplasty for Treatment of Carpometacarpal Arthritis of the Thumb.

Hustedt, Joshua W / Deeyor, Sorka T / Hui, Clayton H / Vohra, Arjun / Llanes, Aaron C / Silvestri, Briana L

The Journal of hand surgery

2023 Volume 48, Issue 4, Page(s) 348–353

Abstract: Purpose: Trapeziectomy with suspensionplasty is the most popular treatment for thumb carpometacarpal arthritis. However, carpometacarpal denervation has recently shown promise as an alternative treatment option. This study was designed to compare ... ...

Abstract	Purpose: Trapeziectomy with suspensionplasty is the most popular treatment for thumb carpometacarpal arthritis. However, carpometacarpal denervation has recently shown promise as an alternative treatment option. This study was designed to compare functional outcomes, pain reduction, and quality of life between denervation and suspension arthroplasty in patients treated for thumb carpometacarpal osteoarthritis. Methods: We conducted a prospective clinical trial between June 2020 and December 2021. Preoperative and postoperative evaluations were conducted on patients, including the evaluation of functional outcomes via the Michigan Hand Outcomes Questionnaire, pain with the visual analog score, quality of life with the EuroQol-5D, and the evaluation of time to return to function. Outcomes and complications were compared between patients undergoing denervation versus arthroplasty. Results: Forty-eight patients were included in the study, 34 of whom underwent denervation and 14 underwent suspension arthroplasty of the thumb carpometacarpal joint. Patients in the denervation group were younger, with an average age of 59 years compared with 67 years in the arthroplasty group. All other patient characteristics were similar. Pain reduction, functional outcomes, and quality of life scores showed equal improvement in both groups. Denervation patients had a reduced time to return to function (3.3 weeks vs 4.5 months in the arthroplasty group). Conclusions: Carpometacarpal denervation appears to provide similar short-term outcomes as suspension arthroplasty for the treatment of thumb carpometacarpal arthritis. Treatment with denervation may offer a quicker return to function. The long-term outcomes of denervation remain unknown. Type of study/level of evidence: Therapeutic IV.
MeSH term(s)	Humans ; Middle Aged ; Arthroplasty ; Carpometacarpal Joints/surgery ; Denervation ; Osteoarthritis/surgery ; Pain ; Prospective Studies ; Quality of Life ; Thumb/surgery
Language	English
Publishing date	2023-02-01
Publishing country	United States
Document type	Clinical Trial ; Journal Article
ZDB-ID	605716-0
ISSN	1531-6564 ; 0363-5023
ISSN (online)	1531-6564
ISSN	0363-5023
DOI	10.1016/j.jhsa.2022.11.021
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Article ; Online: Plesiomonas shigelloides Periprosthetic Knee Infection After Consumption of Raw Oysters.

Hustedt, Joshua W / Ahmed, Sarim

American journal of orthopedics (Belle Mead, N.J.)

2017 Volume 46, Issue 1, Page(s) E32–E34

Abstract: Periprosthetic infections are a leading cause of morbidity after total joint arthroplasty. Common pathogens include Staphylococcus aureus, streptococcus, enterococcus, Escherichia coli, and Pseudomonas aeruginosa. However, there are many cases in which ... ...

Abstract	Periprosthetic infections are a leading cause of morbidity after total joint arthroplasty. Common pathogens include Staphylococcus aureus, streptococcus, enterococcus, Escherichia coli, and Pseudomonas aeruginosa. However, there are many cases in which rare bacteria are isolated. This case report describes a periprosthetic knee infection caused by Plesiomonas shigelloides. In the United States, P shigelloides and 2 other Vibrionaceae family members, Vibrio vulnificus and Vibrio parahaemolyticus, are most often contracted from eating raw oysters and shellfish. P shigelloides usually causes a self-limiting watery diarrhea, but in immunosuppressed people it can cause septicemia. In this case report, a chemically and biologically immunosuppressed man consumed raw oysters and developed P shigelloides septicemia and acute periprosthetic knee infection that required surgical intervention.
MeSH term(s)	Aged ; Animals ; Debridement ; Gram-Negative Bacterial Infections/etiology ; Gram-Negative Bacterial Infections/microbiology ; Gram-Negative Bacterial Infections/surgery ; Humans ; Male ; Ostreidae/microbiology ; Plesiomonas/isolation & purification ; Prosthesis-Related Infections/etiology ; Prosthesis-Related Infections/microbiology ; Prosthesis-Related Infections/surgery ; Seafood/adverse effects ; Seafood/microbiology ; Therapeutic Irrigation ; Treatment Outcome
Language	English
Publishing date	2017-01
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2365753-4
ISSN	1934-3418 ; 1078-4519
ISSN (online)	1934-3418
ISSN	1078-4519
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Article ; Online: Provider Bias in prescribing opioid analgesics: a study of electronic medical Records at a Hospital Emergency Department.

Keister, Lisa A / Stecher, Chad / Aronson, Brian / McConnell, William / Hustedt, Joshua / Moody, James W

BMC public health

2021 Volume 21, Issue 1, Page(s) 1518

Abstract: Background: Physicians do not prescribe opioid analgesics for pain treatment equally across groups, and such disparities may pose significant public health concerns. Although research suggests that institutional constraints and cultural stereotypes ... ...

Abstract	Background: Physicians do not prescribe opioid analgesics for pain treatment equally across groups, and such disparities may pose significant public health concerns. Although research suggests that institutional constraints and cultural stereotypes influence doctors' treatment of pain, prior quantitative evidence is mixed. The objective of this secondary analysis is therefore to clarify which institutional constraints and patient demographics bias provider prescribing of opioid analgesics. Methods: We used electronic medical record data from an emergency department of a large U.S hospital during years 2008-2014. We ran multi-level logistic regression models to estimate factors associated with providing an opioid prescription during a given visit while controlling for ICD-9 diagnosis codes and between-patient heterogeneity. Results: A total of 180,829 patient visits for 63,513 unique patients were recorded during the period of analysis. Overall, providers were significantly less likely to prescribe opioids to the same individual patient when the visit occurred during higher rates of emergency department crowding, later times of day, earlier in the week, later years in our sample, and when the patient had received fewer previous opioid prescriptions. Across all patients, providers were significantly more likely to prescribe opioids to patients who were middle-aged, white, and married. We found no bias towards women and no interaction effects between race and crowding or between race and sex. Conclusions: Providers tend to prescribe fewer opioids during constrained diagnostic situations and undertreat pain for patients from high-risk and marginalized demographic groups. Potential harms resulting from previous treatment decisions may accumulate by informing future treatment decisions.
MeSH term(s)	Analgesics, Opioid/therapeutic use ; Electronic Health Records ; Emergency Service, Hospital ; Female ; Hospitals ; Humans ; Middle Aged ; Practice Patterns, Physicians'
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2021-08-06
Publishing country	England
Document type	Journal Article
ISSN	1471-2458
ISSN (online)	1471-2458
DOI	10.1186/s12889-021-11551-9
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Article ; Online: Letter to the Editor regarding Kolk et al: "Does acromioplasty result in favorable clinical and radiologic outcomes in the management of chronic subacromial pain syndrome? A double-blinded clinical trial with 9 to 14 years' follow-up".

Hustedt, Joshua W / Harmsen, Samuel M / Lederman, Evan S

Journal of shoulder and elbow surgery

2018 Volume 27, Issue 3, Page(s) e82–e83

MeSH term(s)	Acromion/surgery ; Arthroplasty ; Follow-Up Studies ; Humans ; Pain
Language	English
Publishing date	2018-01-04
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	1170782-3
ISSN	1532-6500 ; 1058-2746
ISSN (online)	1532-6500
ISSN	1058-2746
DOI	10.1016/j.jse.2017.11.001
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Zs.A 3973: Show issues

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Article ; Online: Physician Professional Fees Are Declining and Inpatient and Outpatient Facility Fees Are Increasing for Orthopaedic Procedures in the United States.

Hui, Clayton H / Kisana, Haroon / Martin, John R / Steecher, Chad / Carter, Thomas / Lederman, Evan / Hustedt, Joshua W

Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association

2022 Volume 39, Issue 2, Page(s) 384–389.e6

Abstract: Purpose: To examine the trends in physician professional fees and inpatient and outpatient facility fees in orthopaedic surgery in the United States.: Methods: Physician professional fees and inpatient and outpatient facility fees were tracked from ... ...

Abstract	Purpose: To examine the trends in physician professional fees and inpatient and outpatient facility fees in orthopaedic surgery in the United States. Methods: Physician professional fees and inpatient and outpatient facility fees were tracked from 2008 to 2021 for the most common orthopaedic procedures in each orthopaedic subspecialty. Using common procedure codes for physician and outpatient procedures and Medicare severity diagnosis related group codes for inpatient procedures, the Medicare Physician Fee Schedules were used to obtain the national payment amounts for physician professional fees and inpatient and outpatient facility fees. Trends in fees were tracked over time after adjustment for inflation. Results: From 2008 to 2021, physician professional fees decreased by an average of 20%, whereas inpatient facility fees increased by 15%, and outpatient facility fees increased by 72%. The orthopaedic subspecialty with the largest decrease in physician professional fees was oncology, with an average decrease of 23.5%, followed by general orthopaedics (23.1%), and sports medicine (22.8%). The largest increase in outpatient facility fees was seen in the subspecialties of general orthopaedics (149.8%), spine (130.1%), and trauma (123.0%). Conclusions: Over the past 13 years, physician professional fees for the most common orthopaedic procedures have declined while inpatient and outpatient facility fees have increased. Understanding these changes is important to the practice of orthopaedic surgery in the United States. Level of evidence: IV, economic.
MeSH term(s)	Aged ; Humans ; United States ; Medicare ; Inpatients ; Outpatients ; Orthopedic Procedures ; Orthopedics
Language	English
Publishing date	2022-10-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	632528-2
ISSN	1526-3231 ; 0749-8063
ISSN (online)	1526-3231
ISSN	0749-8063
DOI	10.1016/j.arthro.2022.08.040
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