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Article ; Online: AAOS Clinical Practice Guideline Summary: Prevention of Surgical Site Infection After Major Extremity Trauma.

Goldman, Ashton H / Tetsworth, Kevin

The Journal of the American Academy of Orthopaedic Surgeons

2022 Volume 31, Issue 1, Page(s) e1–e8

Abstract: Prevention of Surgical Site Infections After Major Extremity Trauma Evidence-Based Clinical Practice Guideline is based on a systematic review of current scientific and clinical research. This clinical practice guideline (CPG) is designed to assist ... ...

Abstract	Prevention of Surgical Site Infections After Major Extremity Trauma Evidence-Based Clinical Practice Guideline is based on a systematic review of current scientific and clinical research. This clinical practice guideline (CPG) is designed to assist qualified physicians and clinicians when making treatment decisions for adults (18 years or older) who have sustained major extremity trauma. The CPG workgroup defined major extremity trauma as an open fracture, a major/high-energy closed fracture, a degloving injury, Morel-Lavallée lesions, a low-energy or high-energy gunshot injury, a crush injury, a blast injury, or any other moderate-energy to high-energy injury. This guideline contains 14 recommendations that evaluate preoperative, perioperative, and postoperative interventions to limit the risk of surgical site infections after major extremity trauma while also identifying and evaluating potential patient-specific risk factors to consider. Another six options formulated with either low-quality evidence, no evidence, or conflicting evidence are also presented and discussed in the CPG. These include the use of incisional negative-pressure wound therapy for high-risk surgical incisions, the implementation of an orthoplastic team, the possible role of hyperbaric O2, the value of various preoperative skin preparations, and select modifiable and administrative risk factors.
MeSH term(s)	Adult ; Humans ; Surgical Wound Infection/etiology ; Surgical Wound Infection/prevention & control ; Fractures, Open ; Negative-Pressure Wound Therapy ; Extremities ; Risk Factors
Language	English
Publishing date	2022-11-03
Publishing country	United States
Document type	Systematic Review ; Journal Article
ZDB-ID	1200524-1
ISSN	1940-5480 ; 1067-151X
ISSN (online)	1940-5480
ISSN	1067-151X
DOI	10.5435/JAAOS-D-22-00792
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Article: A simplified approach for the surgical treatment of hip and knee periprosthetic joint infections.

Sanderson, Galen / Olsen, Aaron / Nabet, Austin / Goldman, Ashton

Journal of orthopaedics

2023 Volume 47, Page(s) 58–62

Language	English
Publishing date	2023-11-11
Publishing country	India
Document type	Journal Article ; Review
ZDB-ID	2240839-3
ISSN	0972-978X
ISSN	0972-978X
DOI	10.1016/j.jor.2023.11.005
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Article ; Online: Oral opioid prescribing to active duty US military personnel: a cross-sectional population.

Junge, Joshua M / Murray, Hailey / Goldman, Ashton H / Booth, Gregory J / Balazs, George C

Regional anesthesia and pain medicine

2024 Volume 49, Issue 5, Page(s) 339–345

Abstract: Introduction: While civilian opioid prescriptions have seen a dramatic decline in recent years, there are few studies investigating trends in opioid prescription in the active duty military population. We evaluated oral opioid prescribing patterns to ... ...

Abstract	Introduction: While civilian opioid prescriptions have seen a dramatic decline in recent years, there are few studies investigating trends in opioid prescription in the active duty military population. We evaluated oral opioid prescribing patterns to active duty military personnel in the Military Health System (MHS) from 2017 to 2020 to determine the incidence of opioid prescriptions as well as demographic and military-specific risk factors for receiving an oral opioid prescription. Methods: The MHS Data Repository was queried from 2017 to 2020 to identify all outpatient oral opioid prescriptions to active duty military personnel in August of each year as well as demographic information on the study population. Data were evaluated in a logistic regression model, and ORs of receiving an oral opioid prescription were calculated for each factor. Results: The proportion of active duty military personnel receiving an oral opioid prescription declined from 2.71% to 1.26% (53% relative reduction) over the study period. Within the logistic regression model, female military personnel were significantly more likely to receive opioid prescriptions compared with men, and there was a stepwise increase in likelihood of an opioid prescription with increasing age. Army and Marine personnel, personnel without a history of military deployment and those stationed within the continental USA were significantly more likely to receive an opioid prescription. Discussion: The substantial decrease in oral opioid prescriptions to active duty military personnel mirrors data published in the civilian community. The identified risk factors for receiving an opioid prescription may be potential targets for future interventions to further decrease prescribing.
MeSH term(s)	Humans ; Military Personnel ; Analgesics, Opioid/administration & dosage ; Analgesics, Opioid/therapeutic use ; Female ; Male ; Adult ; United States/epidemiology ; Cross-Sectional Studies ; Administration, Oral ; Drug Prescriptions ; Practice Patterns, Physicians'/trends ; Young Adult ; Middle Aged
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2024-05-07
Publishing country	England
Document type	Journal Article
ZDB-ID	1425299-5
ISSN	1532-8651 ; 1098-7339 ; 0146-521X
ISSN (online)	1532-8651
ISSN	1098-7339 ; 0146-521X
DOI	10.1136/rapm-2023-104495
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Article ; Online: Patient reported outcome measures (PROMs) as primary and secondary outcomes in total hip and knee arthroplasty randomized controlled trials: a systematic review.

Reiter, Charles R / Abraham, Vivek M / Riddle, Daniel L / Patel, Nirav K / Goldman, Ashton H

Archives of orthopaedic and trauma surgery

2024 Volume 144, Issue 5, Page(s) 2257–2266

Abstract: Background: Significant heterogeneity exists regarding patient reported outcome measures (PROMs) used in total hip (THA) and knee (TKA) arthroplasty randomized controlled trials (RCTs). This study investigates the PROMs used as primary and secondary ... ...

Abstract	Background: Significant heterogeneity exists regarding patient reported outcome measures (PROMs) used in total hip (THA) and knee (TKA) arthroplasty randomized controlled trials (RCTs). This study investigates the PROMs used as primary and secondary outcomes in contemporary arthroplasty RCTs. Methods: A literature search identified THA and TKA RCTs that were published in top ten impact factor orthopaedic journals from 2017 to 2021. Screening identified 241 trials: 76 THA, 157 TKA, and eight combined. Data were extracted to identify PROMs utilized as either primary or secondary outcomes and the time period of measurement. Results: Visual Analog Scale (VAS) Pain was the most reported primary PROM in THA (9.2%) and TKA (22.9%) trials. This was followed by Numeric Rating Scale (NRS) Pain (7.9%) and the Harris Hip score (6.6%) in THA trials and NRS Pain (4.5%) and the Knee Society score (4.5%) in TKA trials. Many THA (37.0%) and TKA (52.1%) trials did not clearly specify primary outcome time points. Only pain scales were reported at time points less than one week, while various joint-specific functional outcomes were reported at later time points. As secondary outcomes, the Harris Hip score (28.9%) was most common in THA trials and the Knee Society score (26.1%) was most common in TKA trials. Indeterminate primary or secondary outcomes were reported in 18.2% of studies. Conclusions: Contemporary THA and TKA trials exhibit heterogeneity of PROMs as study outcomes after the first postoperative week. Our findings highlight the need for consensus in PROM reporting and better methodological reporting to improve the interpretability of RCT outcomes. Prospero registration number: CRD42022337255.
MeSH term(s)	Humans ; Arthroplasty, Replacement, Knee ; Patient Reported Outcome Measures ; Arthroplasty, Replacement, Hip ; Randomized Controlled Trials as Topic ; Pain Measurement
Language	English
Publishing date	2024-04-01
Publishing country	Germany
Document type	Journal Article ; Systematic Review
ZDB-ID	80407-1
ISSN	1434-3916 ; 0003-9330 ; 0344-8444
ISSN (online)	1434-3916
ISSN	0003-9330 ; 0344-8444
DOI	10.1007/s00402-024-05242-4
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Article ; Online: The Surgical Instrument Sterilization Process: What Every Surgeon Should Know.

Land, Vaughn / Dickerson, Samuel / Goldman, Ashton / Shirley, Eric D

JBJS reviews

2023 Volume 11, Issue 11

Abstract: The phases of the sterilization process for surgical equipment are cleaning, disinfection, and sterilization.» Following manufacturer and regulatory guidelines will minimize contamination throughout the sterilization process.» Immediate use steam ... ...

Abstract	» The phases of the sterilization process for surgical equipment are cleaning, disinfection, and sterilization.» Following manufacturer and regulatory guidelines will minimize contamination throughout the sterilization process.» Immediate use steam sterilization, when used appropriately, is a reasonably safe option to be used at the discretion of the operating surgeon.
MeSH term(s)	Humans ; Sterilization ; Surgeons ; Surgical Instruments
Language	English
Publishing date	2023-11-22
Publishing country	United States
Document type	Journal Article
ISSN	2329-9185
ISSN (online)	2329-9185
DOI	e23.00131
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Article: Machine Learning to Predict Discharge Destination After Total Knee Arthroplasty and Total Hip Arthroplasty.

Booth, Gregory J / Cole, Jacob / Geiger, Phil / Balazs, George C / Hughey, Scott / Nepa, Natalie / Goldman, Ashton

Journal of surgical orthopaedic advances

2024 Volume 32, Issue 4, Page(s) 252–258

Abstract: Discharge destination impacts costs and perioperative planning for primary total knee (TKA) or hip arthroplasty (THA). The purpose of this study was to create a tool to predict discharge destination in contemporary patients. Models were developed using ... ...

Abstract	Discharge destination impacts costs and perioperative planning for primary total knee (TKA) or hip arthroplasty (THA). The purpose of this study was to create a tool to predict discharge destination in contemporary patients. Models were developed using more than 400,000 patients from the National Surgical Quality Improvement Program database. Models were compared with a previously published model using area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA). AUC on patients with TKA was 0.729 (95% confidence interval [CI]: 0.719 to 0.738) and 0.688 (95% CI: 0.678 to 0.697) using the new and previous models, respectively. AUC on patients with THA was 0.768 (95% CI: 0.758 to 0.778) and 0.726 (95% CI: 0.714 to 0.737) using the new and previous models, respectively. DCA showed substantially improved net clinical benefit. The new models were integrated into a web-based application. This tool enhances clinical decision making for predicting discharge destination following primary TKA and THA. (Journal of Surgical Orthopaedic Advances 32(4):252-258, 2023).
MeSH term(s)	Humans ; Arthroplasty, Replacement, Knee ; Arthroplasty, Replacement, Hip ; Patient Discharge ; Postoperative Complications ; Machine Learning
Language	English
Publishing date	2024-03-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2189157-6
ISSN	2158-3811 ; 1548-825X ; 1059-1052
ISSN (online)	2158-3811
ISSN	1548-825X ; 1059-1052
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Zs.A 4751: Show issues

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Article ; Online: Disparities in Demographics in Hip Arthroplasty Between U.S. Active Duty Military and the ACS-NSQIP Clinical Registry.

Abraham, Vivek M / Junge, Joshua M / Booth, Greg / Olsen, Aaron A / Balazs, George C / Goldman, Ashton H

Military medicine

2024

Abstract: Introduction: Patient demographics, such as sex and age, are known risk factors for undergoing revision following primary total hip arthroplasty (THA). The military population is unique because of the increased rates of primary and secondary ... ...

Abstract	Introduction: Patient demographics, such as sex and age, are known risk factors for undergoing revision following primary total hip arthroplasty (THA). The military population is unique because of the increased rates of primary and secondary osteoarthritis of the hip. Treatment options are limited for returning patients to their line of duty; however, THA has been shown to be an effective option. The primary purpose of this study was to evaluate and contrast the demographic differences of patients undergoing primary THA between the U.S. active duty military population and the general population. The secondary goal was to identify the proportion of primary THA performed at the MTF within the military health system (MHS). Methods: This was an exempt study determined by the local institutional review board. A retrospective analysis of the MHS Data Repository (MDR) and the National Surgical Quality Improvement Program (NSQIP) was performed. The databases were used to identify the patients who underwent THA from January 1, 2015 to December 31, 2020. The MDR was used to identify demographics such as sex, age, setting of surgery, geographic location, previous military deployments, history of deployment-related injuries, branch of service, and rank. The NSQIP database was queried for sex and age. The median age of the population was compared using the Mann-Whitney U test and gender was compared using the Chi-square test. Results: The MDR was used to evaluate 2,734 patients, whereas the NSQIP database was used to evaluate 223,832 patients. In the military population, patients who underwent THA were 87.7% male with an average age of 45 years, whereas in the general population as measured via the NSQIP database, 45.2% patients were male with an average age of 66.0 years. Comparing the two groups, we demonstrated that the military patients were significantly more likely to be younger (P < .001) and males (P < .001). Only 29.6% of primary THAs were performed within the MTF. Conclusions: Patients in the MHS are undergoing THA at a younger age and are more likely to be male compared to the general population. A significant portion of primary THAs in the MHS are also being performed at civilian institutions. These demographics may result in increased risk of revision; however, long-term studies are warranted to evaluate survivorship in this unique population.
Language	English
Publishing date	2024-02-12
Publishing country	England
Document type	Journal Article
ZDB-ID	391061-1
ISSN	1930-613X ; 0026-4075
ISSN (online)	1930-613X
ISSN	0026-4075
DOI	10.1093/milmed/usae029
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Article: Natural Language Processing and Its Use in Orthopaedic Research.

Wyatt, John M / Booth, Gregory J / Goldman, Ashton H

Current reviews in musculoskeletal medicine

2021 Volume 14, Issue 6, Page(s) 392–396

Abstract: Purpose of review: This review aims to demonstrate how natural language processing is used in orthopaedic research.: Recent findings: Natural language processing is a form of artificial intelligence that involves encoding human-generated text or ... ...

Abstract	Purpose of review: This review aims to demonstrate how natural language processing is used in orthopaedic research. Recent findings: Natural language processing is a form of artificial intelligence that involves encoding human-generated text or speech into a form which can be interpreted by computers to perform a variety of tasks. Natural language processing gathers, processes, and organizes large amounts of free-text data more efficiently than humans. In orthopaedics, it has been utilized for retrospective chart review, automated reporting of electronic health record data, analyzing operative notes and radiology reports, and patient reviews of physicians and practices. Although still in its infancy, natural language processing promises to be a valuable tool in the future of orthopaedic research. It will not eliminate the need for the essential human component of questioning involved in research, but natural language processing can improve the quality, efficiency, and thoroughness of research, thus improving patient care.
Language	English
Publishing date	2021-11-10
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2407827-X
ISSN	1935-9748 ; 1935-973X
ISSN (online)	1935-9748
ISSN	1935-973X
DOI	10.1007/s12178-021-09734-3
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Article ; Online: Examination of Randomized Trials and Corresponding Trial Registry Entries: Registration Timing and Primary Outcome Analysis in the Journal of Arthroplasty.

Riddle, Daniel L / Goldman, Ashton H / Tarver, Talicia / Patel, Nirav K

The Journal of arthroplasty

2022 Volume 37, Issue 8, Page(s) 1645–1649.e7

Abstract: Background: Prospective trial registration enhances transparency and rigor of trial reporting. We conducted an in-depth examination of randomized clinical trials (RCTs) published in The Journal of Arthroplasty (JOA) from 2010 to 2020 and their ... ...

Abstract	Background: Prospective trial registration enhances transparency and rigor of trial reporting. We conducted an in-depth examination of randomized clinical trials (RCTs) published in The Journal of Arthroplasty (JOA) from 2010 to 2020 and their associated trial registries. Methods: We examined all RCTs published in the JOA during the even years between 2010 and 2020. We determined the proportion of trials that were registered and prospectively registered as well as the extent of consistency between primary outcome characteristics in the trials vs the registries. Trial characteristics published between 2010 and 2014 were compared to trials published between 2016 and 2020. Results: A total of 57 (33.7%) of 169 primary RCTs over the study period reported being registered and of these, 20 (11.8%) were prospectively registered. For the registered primary RCTs, 75% reported primary outcome findings that were inconsistent with the corresponding registry. Trial registration proportion substantially improved from 13.6% between 2010 and 2014 to 53% between 2016 and 2020 (z-test = -5.315, P < .001). Conclusion: High proportions of retrospectively registered or unregistered trials and a very high proportion of inconsistencies in reporting of primary outcomes compared to the trial registries were found. These data argue for a well-developed strategy by JOA to enhance editorial policies, reviewer and editorial board member training and oversight, and improved arthroplasty researcher awareness to improve the current state of RCT reporting in JOA.
MeSH term(s)	Arthroplasty ; Humans ; Publications ; Randomized Controlled Trials as Topic ; Registries
Language	English
Publishing date	2022-03-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	632770-9
ISSN	1532-8406 ; 0883-5403
ISSN (online)	1532-8406
ISSN	0883-5403
DOI	10.1016/j.arth.2022.02.105
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Zs.A 2134: Show issues

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Article ; Online: Grit and postoperative opioid use after total joint arthroplasty.

Ernst, Andrew J / Briggs, Avery M / Spooner, Rebecca / Balazs, George C / Goldman, Ashton H

Hip international : the journal of clinical and experimental research on hip pathology and therapy

2023 Volume 34, Issue 2, Page(s) 156–160

Abstract: Introduction: Perioperative multimodal protocols following total joint replacements have significantly decreased the amount of perioperative and postoperative opioids. Further identification of those requiring more or less opioids through ... ...

Abstract	Introduction: Perioperative multimodal protocols following total joint replacements have significantly decreased the amount of perioperative and postoperative opioids. Further identification of those requiring more or less opioids through individualisation, may further aid in reducing the amount prescribed. Therefore, the purpose of the study was to evaluate whether a patient's grit, the measurable psychological strength of character to persevere during hardship, measured by postoperative opioid consumption. Methods: Consecutive patients who had undergone either primary or revision total knee arthroplasty (TKA) or total hip arthroplasty (THA) from February 2019 to August 2020 at our institution logged their opioid use for the first 2 weeks postoperatively, detailing the type, dosage, and number of narcotics they consumed. Those who completed their logs and a grit questionnaire had their average morphine equivalent dose (MED) and grit score calculated. Analysis was then performed to evaluate if any association existed between these 2 variables. Results: There was no correlation between grit score and postoperative opioid consumption in the first 2 weeks following discharge after total joint arthroplasty. A total of 144 patients were eligible to participate and a total of 86 patients met inclusion criteria, 48 patients in the TKA group and 38 in the THA group. Of all patients, 63% were male. The average MED was 95.5 for THAs and 192 for TKAs. The average grit score was 4.23 for THAs and 4.19 for TKAs. Conclusions: There is not an apparent association between grit score and postoperative opioid consumption in the first 2 weeks after total joint arthroplasty. General psychological resiliency may not be an important predictor of postoperative opioid use with modern postoperative protocols.
MeSH term(s)	Humans ; Male ; Female ; Analgesics, Opioid/therapeutic use ; Arthroplasty, Replacement, Hip/adverse effects ; Pain, Postoperative/drug therapy ; Opioid-Related Disorders/etiology ; Opioid-Related Disorders/drug therapy ; Arthroplasty, Replacement, Knee/adverse effects ; Morphine ; Retrospective Studies
Chemical Substances	Analgesics, Opioid ; Morphine (76I7G6D29C)
Language	English
Publishing date	2023-06-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	1162513-2
ISSN	1724-6067 ; 1120-7000
ISSN (online)	1724-6067
ISSN	1120-7000
DOI	10.1177/11207000231176507
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