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Article ; Online: Readability Analysis of Patient Education Material on Rotator Cuff Injuries From the Top 25 Ranking Orthopaedic Institutions.

Miskiewicz, Michael / Capotosto, Salvatore / Ling, Kenny / Hance, Frederick / Wang, Edward

Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews

2024 Volume 8, Issue 5

Abstract: Introduction: Rotator cuff injuries (RCIs) are incredibly common in the US adult population. Forty-three percent of adults have basic or below-basic literacy levels; nonetheless, patient educational materials (PEMs) are frequently composed at levels ... ...

Abstract	Introduction: Rotator cuff injuries (RCIs) are incredibly common in the US adult population. Forty-three percent of adults have basic or below-basic literacy levels; nonetheless, patient educational materials (PEMs) are frequently composed at levels exceeding these reading capabilities. This study investigates the readability of PEMs on RCIs published by leading US orthopaedic institutions. Methods: The top 25 orthopaedic institutions on the 2022 U.S. News & World Report Best Hospitals Specialty Ranking were selected. Readability scores of PEMs related to RCI were calculated using the www.readabilityformulas.com website. Results: Among the 25 analyzed PEM texts, all exceeded the sixth-grade reading level. Only four of 168 scores (2.4%) were below the eighth-grade level. Discussion: This study indicates that PEMs on rotator cuff injuries from top orthopedic institutions are too complex for many Americans, with readability levels ranging from 8.5 to 16th grade, well above the CDC-recommended eighth-grade level. The research highlights a widespread issue with high reading levels across healthcare information and underscores the need for healthcare providers to adopt patient-centered communication strategies to improve comprehension and accessibility. Conclusion: PEMs on rotator cuff injuries from leading orthopedic institutions often have a reading level beyond that of many Americans, exceeding guidelines from the NIH and CDC that recommend PEMs be written at an eighth-grade reading level. To increase accessibility, enhance healthcare literacy, and improve patient outcomes, institutions should simplify these materials to meet recommended readability standards.
MeSH term(s)	Humans ; Comprehension ; Patient Education as Topic ; Rotator Cuff Injuries ; United States ; Health Literacy ; Orthopedics
Language	English
Publishing date	2024-05-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2898328-2
ISSN	2474-7661 ; 1067-151X
ISSN (online)	2474-7661
ISSN	1067-151X
DOI	e24.00085
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Chronic Steroid Use Does Not Increase the Risk of Superficial Surgical Site Infection or Wound Dehiscence Following Total Ankle Arthroplasty.

Garcia, Alexander R / Ling, Kenny / Olsen, Evan / Komatsu, David E / Paulus, Megan

Cureus

2024 Volume 16, Issue 1, Page(s) e52569

Abstract: Introduction Total ankle arthroplasty (TAA) is an effective treatment for end-stage ankle arthritis. Recent surgical and technological advances have led to a significant increase in the surgical volume of TAA. While a majority of ankle arthritis is post- ... ...

Abstract	Introduction Total ankle arthroplasty (TAA) is an effective treatment for end-stage ankle arthritis. Recent surgical and technological advances have led to a significant increase in the surgical volume of TAA. While a majority of ankle arthritis is post-traumatic in nature, other causes include autoimmune or inflammatory conditions. Medical management of these conditions frequently requires chronic corticosteroid administration, which is a well-established risk factor for complications following surgery. The purpose of this study was to investigate the association between chronic preoperative steroid use and postoperative complications following TAA. Methods The American College of Surgeons National Surgical Quality Improvement (NSQIP) database was analyzed to identify all patients who underwent TAA between 2015 and 2020. Patient characteristics including demographics, comorbidities, surgical characteristics, and 30-day postoperative complication data were collected. The data was analyzed using bivariate and multivariate logistic regression to identify all postoperative complications associated with chronic preoperative steroid use. Results A total of 1,606 patients were included in this study: 1,533 (95.5%) were included in the non-steroid cohort, and 73 (4.5%) were included in the chronic steroid cohort. Chronic steroid use was significantly associated with female sex (p < 0.001) and American Society of Anesthesiologists (ASA) ≥3 (p < 0.001). Chronic steroid use was not associated with superficial surgical site infection (SSI) (p = 0.634) or wound dehiscence (p = 0.999). The postoperative complication that was significantly associated with chronic steroid use was sepsis (p = 0.031). After adjusting for female sex and the ASA grade, chronic steroid use was found to be independently associated with sepsis (p = 0.013). Conclusion Preoperative chronic steroid use is not associated with superficial SSI or wound dehiscence within 30 days following TAA. As TAA becomes a more attractive alternative to ankle arthrodesis, a better understanding of preoperative risk factors can aid in widening indications and knowing what patients are at risk for complications.
Language	English
Publishing date	2024-01-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.52569
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Article ; Online: Preoperative Anemia as a Risk Factor for Postoperative Complications After Open Reduction Internal Fixation of Distal Radius Fractures.

Garcia, Alexander R / Ling, Kenny / Al-Humadi, Samer / Komatsu, David E / Wang, Edward D

Journal of hand surgery global online

2023 Volume 5, Issue 6, Page(s) 804–809

Abstract: Purpose: The incidence of distal radius fractures (DRFs) in the United States is more than 640,000 cases per year and is projected to increase. The overall prevalence of anemia in the United States increased from 5.71% in 2005 to 6.86% in 2018. ... ...

Abstract	Purpose: The incidence of distal radius fractures (DRFs) in the United States is more than 640,000 cases per year and is projected to increase. The overall prevalence of anemia in the United States increased from 5.71% in 2005 to 6.86% in 2018. Therefore, preoperative anemia may be an important risk factor to consider before surgical fixation of a distal radius fracture. The purpose of this study was to investigate preoperative anemia and its association with short-term complications after surgical treatment of DRFs. Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent open reduction internal fixation (ORIF) of DRFs between 2015 and 2020. The initial pool of patients was divided into cohorts based on preoperative hematocrit. Multivariate logistic regression, adjusted for all significantly associated patient demographics and comorbidities, was used to identify associations between preoperative anemia and postoperative complications after ORIF of DRFs. Results: A total of 22,923 patients who underwent ORIF of DRFs were identified in National Surgical Quality Improvement Program from 2015 to 2020. Of the 12,068 patients remaining after exclusion criteria, 9,616 (79.7%) patients were included in the normal cohort, 2,238 (18.5%) patients were included in the mild anemia cohort, and 214 (1.8%) patients were included in the severe anemia cohort. Compared with the reference cohort, patients with any anemia were independently associated with higher rates of reintubation (odds ratio [OR], 6.51; 95% confidence interval [CI], 1.29-32.80; Conclusions: Preoperative anemia, both mild and severe, were clinically significant predictors for postoperative complications within 30-day after ORIF of DRFs. Severe anemia was associated with higher rates of blood transfusion, nonhome discharge, and mortality compared with mild anemia. Type of study/level of evidence: Prognostic III.
Language	English
Publishing date	2023-08-26
Publishing country	United States
Document type	Journal Article
ISSN	2589-5141
ISSN (online)	2589-5141
DOI	10.1016/j.jhsg.2023.07.013
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Article ; Online: Chronic steroid use as a risk factor for postoperative complications following arthroscopic rotator cuff repair.

Fassler, Richelle / Ling, Kenny / Tantone, Ryan / Komatsu, David E / Wang, Edward D

JSES international

2023 Volume 7, Issue 5, Page(s) 780–785

Abstract: Background: Steroids are a common treatment for many rheumatologic and inflammatory disorders. Chronic steroid use has been studied in joint arthroplasty and arthroscopy, but studies specifically on preoperative chronic steroid use in arthroscopic ... ...

Abstract	Background: Steroids are a common treatment for many rheumatologic and inflammatory disorders. Chronic steroid use has been studied in joint arthroplasty and arthroscopy, but studies specifically on preoperative chronic steroid use in arthroscopic rotator cuff repair (aRCR) are limited. The purpose of this study is to determine the association between chronic steroid use and 30-day postoperative outcomes following aRCR. Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) was queried to identify all patients who underwent aRCR between 2015 and 2020. Patients were divided into 2 cohorts: nonsteroid users and chronic steroid users. Univariate binomial regression analysis was used to compare demographics, comorbidities, and postoperative outcomes between cohorts. Multivariate regression analysis, adjusted for all significant demographics and comorbidities, was used to identify significant 30-day postoperative outcomes. Results: A total of 39,876 patients remained after exclusion criteria, with 39,068 (97.97%) in the nonsteroid group and 808 (2.02%) in the chronic steroid group. Patient demographics and comorbidities significantly associated with chronic steroid use were age ≥65 ( Conclusion: Chronic steroid use was not found to be an independent risk factor for infection, readmission, or reoperation following aRCR. It was, however, found to be independently associated with higher rates of 30-day mortality following aRCR, although with a limited overall number of deaths reported.
Language	English
Publishing date	2023-06-09
Publishing country	United States
Document type	Journal Article
ISSN	2666-6383
ISSN (online)	2666-6383
DOI	10.1016/j.jseint.2023.05.015
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Disparities in postoperative total shoulder arthroplasty outcomes between Black and White patients.

Ling, Kenny / Leatherwood, William / Fassler, Richelle / Burgan, Jane / Komatsu, David E / Wang, Edward D

JSES international

2023 Volume 7, Issue 5, Page(s) 842–847

Abstract: Background: Despite the rise in surgical volume for total shoulder arthroplasty (TSA) procedures, racial disparities exist in outcomes between White and Black populations. The purpose of this study was to compare 30-day postoperative complication rates ... ...

Abstract	Background: Despite the rise in surgical volume for total shoulder arthroplasty (TSA) procedures, racial disparities exist in outcomes between White and Black populations. The purpose of this study was to compare 30-day postoperative complication rates between Black and White patients following TSA. Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried for all patients who underwent TSA between 2015 and 2019. Patient demographics and comorbidities were compared between cohorts using bivariate analysis. Multivariate logistic regression, adjusted for all significantly associated patient demographics and comorbidities, was used to identify associations between Black or African American race and postoperative complications. Results: A total of 19,733 patients were included in the analysis, 18,669 (94.6%) patients in the White cohort and 1064 (5.4%) patients in the Black or African American cohort. Demographics and comorbidities that were significantly associated with Black or African American race were age 40-64 years ( Conclusion: Black or African American race was independently associated with higher rates of 30-day readmission following TSA.
Language	English
Publishing date	2023-05-26
Publishing country	United States
Document type	Journal Article
ISSN	2666-6383
ISSN (online)	2666-6383
DOI	10.1016/j.jseint.2023.05.009
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Readmission and Reoperation Following Carpometacarpal Arthroplasty.

Ling, Kenny / Fassler, Richelle / Burgan, Jane / Komatsu, David E / Wang, Edward D

Journal of hand surgery global online

2023 Volume 5, Issue 5, Page(s) 661–666

Abstract: Purpose: Carpometacarpal (CMC) arthroplasty is an effective surgical treatment for osteoarthritis of the CMC joint. Risk factors for readmission and reoperation have been studied for other joint arthroplasty procedures but have not yet been studied for ... ...

Abstract	Purpose: Carpometacarpal (CMC) arthroplasty is an effective surgical treatment for osteoarthritis of the CMC joint. Risk factors for readmission and reoperation have been studied for other joint arthroplasty procedures but have not yet been studied for CMC arthroplasty. The purpose of this study was to identify patient demographics and comorbidities associated with 30-day readmission and 30-day reoperation after CMC arthroplasty. Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for all records of patients who underwent CMC arthroplasty between 2015 and 2020. Variables collected in this study included patient demographics, comorbidities, surgical characteristics, and 30-day postsurgical complication data. Multivariate logistic regression was used to identify independent associations between patient characteristics and readmission and reoperation after CMC arthroplasty. Results: In total, 6,432 records were included in this study: 34 (0.5%) were readmitted within 30 days, and 27 (0.4%) underwent reoperation within 30 days. Compared with the non-readmission cohort, the readmission cohort was significantly associated with higher rates of age ≥ 75 years ( Conclusion: The clinically significant predictors for 30-day readmission and 30-reoperation after CMC arthroplasty were age ≥ 75 years, BMI ≥ 40 kg/m Type of study/level of evidence: Prognostic III.
Language	English
Publishing date	2023-07-27
Publishing country	United States
Document type	Journal Article
ISSN	2589-5141
ISSN (online)	2589-5141
DOI	10.1016/j.jhsg.2023.06.014
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Six-Item Modified Frailty Index independently predicts complications following total shoulder arthroplasty.

Ling, Kenny / Achonu, Justice U / Martino, Robert / Liu, Steven H / Komatsu, David E / Wang, Edward D

JSES international

2023 Volume 8, Issue 1, Page(s) 99–103

Abstract: Background: In the realm of orthopedic surgery, frailty has been associated with higher rates of complications following total hip and total knee arthroplasties. Among various measures of frailty, the Six-Item Modified Frailty Index (MF-6) has recently ... ...

Abstract	Background: In the realm of orthopedic surgery, frailty has been associated with higher rates of complications following total hip and total knee arthroplasties. Among various measures of frailty, the Six-Item Modified Frailty Index (MF-6) has recently gained popularity as a predictor for postoperative complications. The purpose of this study was to investigate MF-6 as a predictor for early postoperative complications in the elderly patient population following total shoulder arthroplasty (TSA). Methods: The authors queried the American College of Surgeons National Surgical Quality Improvement Program database for all patients who underwent TSA between 2015 and 2020. Patient demographics and comorbidities were compared between cohorts using bivariate logistic regression analysis. Multivariate logistic regression, adjusted for all significantly associated patient demographics and comorbidities, was used to identify associations between the MF-6 score and postoperative complications. Results: Of total, 9228 patients were included in this study: 8764 (95.0%) had MF-6 <3, and 464 (5.0%) patients had MF-6 ≥3. Multivariate analysis found MF-6 ≥3 to be independently associated with higher rates of urinary tract infection (odds ratio [OR]: 2.79, 95% confidence interval [CI]: 1.49-5.23; Conclusion: A high MF-6 score (≥3) in patients aged 65 and older is independently associated with higher rates of urinary tract infection, blood transfusion, readmission, and non-home discharge following TSA. The MF-6 score can be easily calculated preoperatively and may allow for better preoperative risk stratification.
Language	English
Publishing date	2023-09-14
Publishing country	United States
Document type	Journal Article
ISSN	2666-6383
ISSN (online)	2666-6383
DOI	10.1016/j.jseint.2023.08.010
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: A comprehensive analysis of age and 30-day complications following total shoulder arthroplasty: nonagenarians, octogenarians, and septuagenarians.

Ling, Kenny / Fassler, Richelle P / Nicholson, Andrew J / Komatsu, David E / Wang, Edward D

JSES international

2023 Volume 8, Issue 1, Page(s) 176–184

Abstract: Background: Increased age is a well-known risk factor for development of osteoarthritis. Total shoulder arthroplasty (TSA) is a common treatment option for patients with severe glenohumeral osteoarthritis. The purpose of this study was to investigate ... ...

Abstract	Background: Increased age is a well-known risk factor for development of osteoarthritis. Total shoulder arthroplasty (TSA) is a common treatment option for patients with severe glenohumeral osteoarthritis. The purpose of this study was to investigate the association between the septuagenarian, octogenarian, and nonagenarian populations and postoperative outcomes following TSA. Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent TSA between 2015 and 2020. Patients were divided into cohorts based on age: sexagenarians (60-69), septuagenarians (70-79), octogenarians (80-89), and nonagenarians (90+). Multivariate logistic regression was used to identify associations between age and postoperative complications. Results: On bivariate analysis, compared to sexagenarians, septuagenarians were significantly associated with higher rates of myocardial infarction ( Conclusion: From age 60, each decade of age was identified to be an increasingly significant predictor for blood transfusion, readmission, and nonhome discharge following TSA. From age 70, each decade of age was additionally identified to be an increasingly significant predictor for mortality.
Language	English
Publishing date	2023-10-21
Publishing country	United States
Document type	Journal Article
ISSN	2666-6383
ISSN (online)	2666-6383
DOI	10.1016/j.jseint.2023.08.025
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Components of metabolic syndrome as significant risk factors for postoperative complications following total shoulder arthroplasty: hypertension, diabetes, and obesity.

Fassler, Richelle / Ling, Kenny / Burgan, Jane / Komatsu, David E / Wang, Edward D

JSES international

2023 Volume 8, Issue 1, Page(s) 141–146

Abstract: Background: Metabolic syndrome (MetS) is a known risk factor for adverse postoperative outcomes. However, the literature surrounding the effects of MetS on orthopedic surgery outcomes following total shoulder arthroplasty (TSA) remains understudied. The ...

Abstract	Background: Metabolic syndrome (MetS) is a known risk factor for adverse postoperative outcomes. However, the literature surrounding the effects of MetS on orthopedic surgery outcomes following total shoulder arthroplasty (TSA) remains understudied. The purpose of this study is to investigate the effect of MetS on postoperative 30-day adverse outcomes following TSA. Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent TSA between 2015 and 2020. After exclusion criteria, patients were divided into MetS and no MetS cohorts. MetS patients were defined as presence of hypertension, diabetes, and body mass index > 30 kg/m Results: A total of 26,613 patients remained after exclusion criteria, with 23,717 (89.1%) in the no MetS cohort and 2896 (10.9%) in the MetS cohort. On multivariate analysis, MetS was found to be an independent predictor of postoperative pneumonia (odds ratio [OR] 1.61, 95% confidence interval [CI] 1.02-2.55; Conclusion: MetS was identified as an independent risk factor for postoperative pneumonia, renal insufficiency, acute renal failure, myocardial infarction, nonhome discharge, and prolonged hospital stay following TSA. These findings encourage physicians to medically optimize MetS patients prior to surgery to limit adverse outcomes.
Language	English
Publishing date	2023-09-22
Publishing country	United States
Document type	Journal Article
ISSN	2666-6383
ISSN (online)	2666-6383
DOI	10.1016/j.jseint.2023.08.019
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Abnormal preoperative leukocyte counts and postoperative complications following total shoulder arthroplasty.

Ling, Kenny / Tsouris, Nicholas / Kim, Matthew / Smolev, Emma / Komatsu, David E / Wang, Edward D

JSES international

2023 Volume 7, Issue 4, Page(s) 601–606

Abstract: Background: Total shoulder arthroplasty (TSA) has become the mainstay of treatment for degenerative glenohumeral arthritis, proximal humerus fracture, and rotator cuff arthropathy. The expanding indications for reverse TSA have increased the overall ... ...

Abstract	Background: Total shoulder arthroplasty (TSA) has become the mainstay of treatment for degenerative glenohumeral arthritis, proximal humerus fracture, and rotator cuff arthropathy. The expanding indications for reverse TSA have increased the overall demand for TSA. This necessitates higher quality preoperative testing and risk stratification. White blood cell counts can be obtained from routine preoperative complete blood count testing. The association between abnormal preoperative white blood cell counts and postoperative complications has not been extensively studied. The purpose of this study was to investigate the association between abnormal preoperative leukocyte counts and 30-day postoperative complications following TSA. Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent TSA between 2015-2020. Patient demographics, comorbidities, surgical characteristics, and 30-day postoperative complication data were collected. Multivariate logistic regression was used to identify postoperative complications associated with preoperative leukopenia and leukocytosis. Results: In this study, 23,341 patients were included: 20,791 (89.1%) were in the normal cohort, 1307 (5.6%) were in the leukopenia cohort, and 1243 (5.3%) were in the leukocytosis cohort. Preoperative leukopenia was significantly associated with higher rates of bleeding transfusions ( Conclusion: Preoperative leukopenia is independently associated with higher rates of deep vein thrombosis within 30 days following TSA. Preoperative leukocytosis is independently associated with higher rates of pneumonia, pulmonary embolism, bleeding transfusion, sepsis, septic shock, readmission, and non-home discharge within 30 days following TSA. Understanding the predictive value of abnormal preoperative lab values will aid in perioperative risk stratification and minimize postoperative complications.
Language	English
Publishing date	2023-04-04
Publishing country	United States
Document type	Journal Article
ISSN	2666-6383
ISSN (online)	2666-6383
DOI	10.1016/j.jseint.2023.03.001
Database	MEDical Literature Analysis and Retrieval System OnLINE

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