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Artikel: Complex lymphatic anomalies: Challenging diagnostic considerations.

Kothandaraman, Venkatraman / Wisener, John / Helgerson, Paul W

2023 Band 12, Heft 1, Seite(n) e8370

Abstract: Diagnosis of complex lymphatic anomalies can be difficult, and biopsies can be associated with significant morbidity. Mediastinal masses with features such as osseous involvement warrant thorough noninvasive evaluation prior to biopsy. ...

Abstract	Diagnosis of complex lymphatic anomalies can be difficult, and biopsies can be associated with significant morbidity. Mediastinal masses with features such as osseous involvement warrant thorough noninvasive evaluation prior to biopsy.
Sprache	Englisch
Erscheinungsdatum	2023-12-29
Erscheinungsland	England
Dokumenttyp	Case Reports
ZDB-ID	2740234-4
ISSN	2050-0904
ISSN	2050-0904
DOI	10.1002/ccr3.8370
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Effect of regional versus general anesthesia on thirty-day outcomes following carotid endarterectomy: a cohort study.

Kline, Leigh A / Kothandaraman, Venkatraman / Knio, Ziyad O / Zuo, Zhiyi

International journal of surgery (London, England)

2023 Band 109, Heft 5, Seite(n) 1291–1298

Abstract: Background: The effect of regional versus general anesthesia on carotid endarterectomy outcomes is debated. This study assesses the effect of anesthetic technique on major morbidity and mortality and additional secondary endpoints following carotid ... ...

Abstract	Background: The effect of regional versus general anesthesia on carotid endarterectomy outcomes is debated. This study assesses the effect of anesthetic technique on major morbidity and mortality and additional secondary endpoints following carotid endarterectomy. Materials and methods: This was a retrospective propensity-matched-cohort analysis investigating elective carotid endarterectomy patients in the 2015-2019 American College of Surgeons National Surgical Quality Improvement Program ( n =37 204). The primary endpoint was 30-day mortality and major morbidity, defined as stroke, myocardial infarction, or death. Secondary endpoints included minor morbidity, bleeding events, healthcare resource utilization, and length of hospital stay. Univariate, multivariable, and survival analyses were applied. Results: The 1 : 1 propensity-matched-cohort included 8304 patients (4152 in each group). Regional anesthesia was associated with similar incidences of major morbidity and mortality [odds ratio (OR), 0.81 (95% CI, 0.61-1.09); P = 0.162] and unplanned resource utilization [OR, 0.93 (95% CI, 0.78-1.11); P = 0.443], but lower incidences of minor morbidity [OR, 0.60 (95% CI, 0.44-0.81); P < 0.001] and bleeding events [OR, 0.49 (95% CI, 0.30-0.78); P = 0.002], and a shorter length of hospital stay [1.4 vs. 1.6 days; mean difference, -0.16 days (95% CI, -0.25 to -0.07); P < 0.001]. On multivariable analysis, regional anesthesia remained independently predictive of minor morbidity [adjusted odds ratio (AOR), 0.58 (95% CI, 0.42-0.79); P = 0.001] and bleeding events [AOR, 0.49 (95% CI, 0.30-0.77); P = 0.003]. Significance was maintained on survival analysis for these two endpoints. A mortality benefit was observed on univariate [OR, 0.50 (95% CI, 0.25-1.00); P = 0.045], multivariable [AOR, 0.49 (95% CI, 0.24-0.96); P = 0.043], and survival analysis ( P = 0.045). Conclusions: Carotid endarterectomy patients receiving regional anesthesia experience favorable outcomes compared to propensity-matched general anesthesia controls.
Mesh-Begriff(e)	Humans ; Cohort Studies ; Retrospective Studies ; Endarterectomy, Carotid/adverse effects ; Anesthesia, Conduction/adverse effects ; Anesthesia, General/adverse effects ; Treatment Outcome ; Risk Factors
Sprache	Englisch
Erscheinungsdatum	2023-05-01
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	2212038-5
ISSN	1743-9159 ; 1743-9191
ISSN (online)	1743-9159
ISSN	1743-9191
DOI	10.1097/JS9.0000000000000356
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Increased perioperative complication rates in patients with solid organ transplants following rotator cuff repair.

Kunkle, Bryce / Reid, Jared / Kothandaraman, Venkatraman / Eichinger, Josef K / Friedman, Richard J

Journal of shoulder and elbow surgery

2021 Band 30, Heft 9, Seite(n) 2048–2055

Abstract: Background: Rotator cuff repair is the second most common soft tissue procedure performed in orthopedics. Additionally, an increasing percentage of the population has received a solid organ transplant (SOT). The chronic use of immunosuppressants as well ...

Abstract	Background: Rotator cuff repair is the second most common soft tissue procedure performed in orthopedics. Additionally, an increasing percentage of the population has received a solid organ transplant (SOT). The chronic use of immunosuppressants as well as a high prevalence of medical comorbidities in this population are both important risk factors when considering surgical intervention. The purpose of this study is to determine the demographic profile, comorbidity profile, and perioperative complication rate of SOT patients undergoing inpatient rotator cuff repair surgery compared to nontransplanted patients. Methods: The Nationwide Inpatient Sample (NIS) database was queried from years 2002-2017 to identify all patients who underwent inpatient rotator cuff repair (n = 144,528 weighted). This group was further divided into SOT (n = 286 weighted) and nontransplant (n = 144,242 weighted) cohorts. Demographic and comorbidity analyses were performed between these groups. Additionally, a matched cohort of nontransplanted patients controlled for the year of procedure, age, sex, race, income, and hospital region was created in a 1:1 ratio to the SOT group (n = 286 each) for perioperative complication rate analysis. Results: Compared to nontransplanted patients, SOT patients were more likely to have at least 1 significant medical comorbidity (98% vs. 69%, P < .001), had a higher number of total comorbidities (3.1 vs. 1.4, P < .001), and had a higher Charlson-Deyo Comorbidity Index (2.6 vs. 0.54, P < .001). Compared to the matched cohort, SOT patients experienced longer hospital stays (2.9 vs. 1.8 days, P < .001), higher surgery costs ($12,031 vs. $8476, P < .001), and were more likely to experience a perioperative complication (24% vs. 3%, P < .001) with an odds ratio of 7.7 (95% confidence interval: 3.9-15.1). Conclusion: Compared with nontransplanted patients, SOT patients undergoing rotator cuff repair had a significantly higher comorbidity index, longer hospital stays, costlier surgeries, and were >7 times more likely to experience a perioperative complication. With nearly a quarter of all SOT patients experiencing a perioperative complication following rotator cuff repair, careful consideration for surgery as well as increased postoperative surveillance should be considered in this unique population.
Mesh-Begriff(e)	Arthroplasty ; Arthroscopy ; Humans ; Organ Transplantation ; Postoperative Complications ; Retrospective Studies ; Rotator Cuff/surgery ; Rotator Cuff Injuries/surgery
Sprache	Englisch
Erscheinungsdatum	2021-02-08
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	1170782-3
ISSN	1532-6500 ; 1058-2746
ISSN (online)	1532-6500
ISSN	1058-2746
DOI	10.1016/j.jse.2020.12.024
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Effects of obesity on clinical and functional outcomes following anatomic and reverse total shoulder arthroplasty.

Reid, Jared J / Kunkle, Bryce F / Kothandaraman, Venkatraman / Roche, Chris / Eichinger, Josef K / Friedman, Richard J

Journal of shoulder and elbow surgery

2021 Band 31, Heft 1, Seite(n) 17–25

Abstract: Background: Limited data exist regarding the clinical and functional outcomes following primary total shoulder arthroplasty in obese patients. The purpose of this study is to determine the effects of obesity on the clinical and functional outcomes ... ...

Abstract	Background: Limited data exist regarding the clinical and functional outcomes following primary total shoulder arthroplasty in obese patients. The purpose of this study is to determine the effects of obesity on the clinical and functional outcomes following primary anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) in a large patient population with mid-term follow-up. Methods: Patients in a multi-institutional shoulder registry receiving either primary aTSA (n = 1520) or rTSA (n = 2054) from 2004 to 2018 with a minimum follow-up period of 2 years were studied. All patients received the same single-platform shoulder prosthesis. Study groups were assigned based on implant type (anatomic or reverse), and further stratification was based on patient body mass index (BMI), with obese patients having a BMI ≥ 30 and non-obese patients having a BMI < 30. Patients were evaluated and scored preoperatively and at latest follow-up by use of 5 scoring metrics and range of motion (ROM). Results: The mean follow-up period was 5 years (range, 2-14 years). Obese patients comprised 41% of the aTSA group and 35% of the rTSA group. Significant postoperative improvements in visual analog scale pain scores, ROM, and all 5 scoring metrics occurred in both obese and non-obese patients (P < .05). Obese patients in both groups reported higher preoperative and postoperative visual analog scale pain scores and less preoperative and postoperative ROM compared with non-obese patients. Compared with non-obese patients, obese patients receiving aTSA reported significantly worse postoperative Simple Shoulder Test, Constant-Murley, American Shoulder and Elbow Surgeons, University of California, Los Angeles, and Shoulder Pain and Disability Index scores compared with non-obese patients, and those receiving rTSA reported significantly worse American Shoulder and Elbow Surgeons and Shoulder Pain and Disability Index scores (all P < .05). However, these differences did not exceed the minimal clinically important difference or substantial clinical benefit criteria. Radiographic analysis showed that in the rTSA group, obese patients had significantly less postoperative scapular notching and a lower scapular notching grade compared with non-obese patients (P < .05). Discussion: Both non-obese and obese patients can expect clinically significant improvements in pain, motion, and functional outcome scores following both aTSA and rTSA. Obese patients reported significantly more postoperative pain, lower outcome scores, and less ROM compared with non-obese patients after both aTSA and rTSA at a mean follow-up of 5 years. However, statistically significant differences were not found to be clinically significant with respect to established minimal clinically important difference and substantial clinical benefit criteria. Therefore, obese and non-obese patients experience similar clinical outcomes following total shoulder arthroplasty, regardless of BMI. However, obese patients have more comorbidities, greater intraoperative blood loss, and less scapular notching compared with non-obese patients.
Mesh-Begriff(e)	Arthroplasty, Replacement, Shoulder ; Humans ; Obesity/complications ; Range of Motion, Articular ; Retrospective Studies ; Shoulder Joint/surgery ; Treatment Outcome
Sprache	Englisch
Erscheinungsdatum	2021-07-20
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	1170782-3
ISSN	1532-6500 ; 1058-2746
ISSN (online)	1532-6500
ISSN	1058-2746
DOI	10.1016/j.jse.2021.06.011
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Orthopaedic Application of Cryotherapy: A Comprehensive Review of the History, Basic Science, Methods, and Clinical Effectiveness.

Kunkle, Bryce F / Kothandaraman, Venkatraman / Goodloe, Jonathan B / Curry, Emily J / Friedman, Richard J / Li, Xinning / Eichinger, Josef K

JBJS reviews

2021 Band 9, Heft 1, Seite(n) e20.00016

Abstract: Cold therapy, also known as cryotherapy, includes the use of bagged ice, ice packs, compressive cryotherapy devices, or whole-body cryotherapy chambers. Cryotherapy is commonly used in postoperative care for both arthroscopic and open orthopaedic ... ...

Abstract	»: Cold therapy, also known as cryotherapy, includes the use of bagged ice, ice packs, compressive cryotherapy devices, or whole-body cryotherapy chambers. Cryotherapy is commonly used in postoperative care for both arthroscopic and open orthopaedic procedures. »: Cryotherapy is associated with an analgesic effect caused by microvasculature alterations that decrease the production of inflammatory mediators, decrease local edema, disrupt the overall inflammatory response, and reduce nerve conduction velocity. »: Postoperative cryotherapy using bagged ice, ice packs, or continuous cryotherapy devices reduced visual analog scale pain scores and analgesic consumption in approximately half of research studies in which these outcomes were compared with no cryotherapy (11 [44%] of 25 studies on pain and 11 [48%] of 23 studies on opioids). However, an effect was less frequently reported for increasing range of motion (3 [19%] of 16) or decreasing swelling (2 [22%] of 9). »: Continuous cryotherapy devices demonstrated the best outcome in orthopaedic patients after knee arthroscopy procedures, compared with all other procedures and body locations, in terms of showing a significant reduction in pain, swelling, and analgesic consumption and increase in range of motion, compared with bagged ice or ice packs. »: There is no consensus as to whether the use of continuous cryotherapy devices leads to superior outcomes when compared with treatment with bagged ice or ice packs. However, complications from cryotherapy, including skin irritation, frostbite, perniosis, and peripheral nerve injuries, can be avoided through patient education and reducing the duration of application. »: Future Level-I or II studies are needed to compare both the clinical and cost benefits of continuous cryotherapy devices to bagged ice or ice pack treatment before continuous cryotherapy devices can be recommended as a standard of care in orthopaedic surgery following injury or surgery.
Mesh-Begriff(e)	Cryotherapy/methods ; Humans ; Orthopedics ; Pain, Postoperative/therapy ; Range of Motion, Articular ; Treatment Outcome
Sprache	Englisch
Erscheinungsdatum	2021-01-26
Erscheinungsland	United States
Dokumenttyp	Journal Article ; Review
ISSN	2329-9185
ISSN (online)	2329-9185
DOI	10.2106/JBJS.RVW.20.00016
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Increased Risk of Perioperative Complications in Dialysis Patients Following Rotator Cuff Repairs and Knee Arthroscopy.

Kothandaraman, Venkatraman / Kunkle, Bryce / Reid, Jared / Oldenburg, Kirsi S / Johnson, Charles / Eichinger, Josef K / Friedman, Richard J

Arthroscopy, sports medicine, and rehabilitation

2021 Band 3, Heft 6, Seite(n) e1651–e1660

Abstract: Purpose: To determine the effects of dialysis on postoperative and perioperative complications following rotator cuff repair (RCR) and knee arthroscopy (KA).: Methods: The National Surgical Quality Improvement Program (NSQIP) was queried from 2006 to ...

Abstract	Purpose: To determine the effects of dialysis on postoperative and perioperative complications following rotator cuff repair (RCR) and knee arthroscopy (KA). Methods: The National Surgical Quality Improvement Program (NSQIP) was queried from 2006 to 2018. Groups were matched for age, sex, body mass index, smoking status, preoperative functional status, and the American Society of Anesthesiologists (ASA) status. Chi-squared tests and Fisher's exact tests were used to analyze the comorbidities. Differences in occurrences of postoperative adverse events (AE), mortality within 30 days, reoperations with 30 days, extended hospital stay (≥2 days), and readmissions within 30 days were analyzed using the Mantel-Haenszel test. Sign tests were used to evaluate differences in operative time, as well as length of hospital stay. Results: Dialysis patients in both the RCR and KA groups had greater odds of experiencing any AE (OR: 6.33 and 7.46, P value: .031 and <.001, respectively) and readmission within 30 days (OR: 10.5 and 4.1, P value: .015 and .014, respectively). They also had significantly greater operating times (P = .049 for both). Dialysis patients undergoing KA had greater odds of staying in the hospital ≥2 days (OR: 10, Conclusions: This study identified significantly worse short-term complication rates in dialysis patients undergoing RCR and KA. Careful preoperative evaluation and postoperative surveillance are warranted in this high-risk patient group. Patients should be counseled appropriately on the increased complication risks associated with RCR and KA surgeries. Level of evidence: Level III, retrospective cohort study.
Sprache	Englisch
Erscheinungsdatum	2021-08-25
Erscheinungsland	United States
Dokumenttyp	Journal Article
ISSN	2666-061X
ISSN (online)	2666-061X
DOI	10.1016/j.asmr.2021.07.021
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Shoulder Position During Magnetic Resonance Arthrogram Significantly Affects Capsular Measurements.

White, Charles Cody / Kothandaraman, Venkatraman / Lin, Jackie / Rao, Meghana / Greenhouse, Alyssa / Barfield, William R / Chapin, Russell / Slone, Harris S / Friedman, Richard J / Eichinger, Josef K

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

2020 Band 37, Heft 1, Seite(n) 17–25

Abstract: Purpose: To determine whether change in shoulder position between internal rotation (IR) and external rotation (ER) during magnetic resonance arthrography (MRA) affects previously defined capsular measurements and to determine the utility of rotation in ...

Abstract	Purpose: To determine whether change in shoulder position between internal rotation (IR) and external rotation (ER) during magnetic resonance arthrography (MRA) affects previously defined capsular measurements and to determine the utility of rotation in the diagnosis of instability. Methods: A retrospective study was conducted of patients who received a shoulder MRA with humeral IR and ER views. Patients with an arthroscopically confirmed diagnosis of instability and those with clinically stable shoulders, no history of instability, and no MRA findings of instability were identified and compared. Humeral rotation, glenoid retroversion, humeral head subluxation, capsular length, and capsular area using axial sequences of IR and ER views were recorded. Analysis compared IR, ER, and Δ capsular measurements between groups using independent t tests and univariate and multivariate regression. Results: Thirty-one subjects who were diagnosed with instability were included, along with 28 control subjects. Capsular length, capsular area, and humeral subluxations were significantly greater with ER compared with IR views (P < .001, P < .001, P < .001). Patients with instability displayed greater ER capsular length (P = .0006) and ER capsular area (P = .005) relative to controls. Multivariate logistic regression identified age, weight, sex, ER capsular length, and retroversion to be significant predictors of instability. ER capsular length independently predicts instability with 86% sensitivity and 84% specificity. Interobserver reliability using the intraclass correlation coefficient was rated good or excellent on all measurements. Conclusion: Variance in humeral rotation during shoulder MRA significantly affects capsular measurements. Rotational views increase the utility of capsular measurements when assessing for instability, particularly capsular length and capsular area. The implementation of ER positioning enhances the ability to examine capsular changes of the shoulder joint and can assist in the diagnosis of instability. Level of evidence: III, retrospective comparative study.
Mesh-Begriff(e)	Adolescent ; Adult ; Arthrography ; Female ; Humans ; Humeral Head/pathology ; Joint Dislocations/diagnostic imaging ; Joint Instability/diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Multivariate Analysis ; Patient Positioning ; Reproducibility of Results ; Retrospective Studies ; Rotation ; Scapula/pathology ; Shoulder/diagnostic imaging ; Shoulder/pathology ; Shoulder Joint/diagnostic imaging ; Young Adult
Sprache	Englisch
Erscheinungsdatum	2020-09-19
Erscheinungsland	United States
Dokumenttyp	Comparative Study ; Journal Article
ZDB-ID	632528-2
ISSN	1526-3231 ; 0749-8063
ISSN (online)	1526-3231
ISSN	0749-8063
DOI	10.1016/j.arthro.2020.09.014
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: The effect of body mass index on internal rotation and function following anatomic and reverse total shoulder arthroplasty.

Eichinger, Josef K / Rao, Meghana V / Lin, Jackie J / Goodloe, Jonathan B / Kothandaraman, Venkatraman / Barfield, William R / Parada, Stephen A / Roche, Christopher / Friedman, Richard J

Journal of shoulder and elbow surgery

2020 Band 30, Heft 2, Seite(n) 265–272

Abstract: Background: The exact relationship between body mass index (BMI) and internal rotation (IR) before and after total shoulder arthroplasty has not been studied to date. The purpose of this study was to determine the effects of BMI on the preoperative and ... ...

Abstract	Background: The exact relationship between body mass index (BMI) and internal rotation (IR) before and after total shoulder arthroplasty has not been studied to date. The purpose of this study was to determine the effects of BMI on the preoperative and postoperative shoulder range of motion and function in anatomic (aTSA) and reverse total shoulder arthroplasty (rTSA), and specifically how IR affects patient ability to perform IR-related activities of daily living (ADLs). Methods: Patients from a prospective multicenter international shoulder arthroplasty registry who underwent primary rTSA (n=1171) and primary aTSA (n=883) were scored preoperatively and at latest follow-up (2-10 years, mean = 3 years) using the Simple Shoulder Test, University of California-Los Angeles shoulder score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, Constant score, and Shoulder Pain and Disability Index patient-reported outcome measures (PROMs). Measured active abduction, forward flexion, IR, and active and passive external rotation were recorded, and BMI was evaluated as a predictor of motion and patient-reported outcomes. Patient responses to questions regarding the difficulty level of IR-related ADLs were studied. The relationships between BMI, IR, and ability to perform IR-related ADLs were quantified through analysis of variance with post hoc comparisons by Tukey honestly significant difference tests, where significance was denoted as P < .05. Results: BMI was found to be inversely correlated with IR in patients undergoing both aTSA and rTSA, both preoperatively (P < .001 and P = .002) and postoperatively (P < .001 and P < .001). BMI affected the range of motion parameters of forward flexion abduction and external rotation but to a lesser extent than that of IR. Nonobese patients demonstrated significantly greater IR than overweight, obese, and morbidly obese patients postoperatively for aTSA (P < .001). For rTSA, nonobese patients had a significantly greater postoperative IR than obese and morbidly obese patients (P < .001 and P = .011, respectively). For both aTSA and rTSA patients, mean IR scores significantly differed between patients reporting normal function vs. patients reporting slight difficulty, considerable difficulty, or inability to perform IR-related ADLs. Increasing IR demonstrated a significant, positive correlation with all PROMs for both aTSA and rTSA patients (Pearson correlation, P < .001). Conclusions: BMI is an independent predictor of IR, even when controlling for age, gender, glenosphere size, and subscapularis repair. BMI was inversely correlated with the degree of IR, and decreased IR significantly negatively affected the ability to perform IR-related ADLs. Clinical relevance: Increasing BMI adversely affects shoulder ROM, particularly IR. IR is correlated with the ability to perform ADLs requiring IR in both aTSA and rTSA patients.
Mesh-Begriff(e)	Activities of Daily Living ; Arthroplasty, Replacement, Shoulder ; Body Mass Index ; Humans ; Obesity, Morbid ; Prospective Studies ; Range of Motion, Articular ; Retrospective Studies ; Rotation ; Shoulder Joint/surgery ; Treatment Outcome
Sprache	Englisch
Erscheinungsdatum	2020-06-30
Erscheinungsland	United States
Dokumenttyp	Journal Article ; Multicenter Study
ZDB-ID	1170782-3
ISSN	1532-6500 ; 1058-2746
ISSN (online)	1532-6500
ISSN	1058-2746
DOI	10.1016/j.jse.2020.06.008
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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