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  1. Article ; Online: Variation in radial head fracture treatment recommendations in terrible triad injuries is not influenced by viewing two-dimensional computed tomography.

    Perloff, Eric M / Crijns, Tom J / O'Connor, Casey M / Ring, David / Marinello, Patrick G

    Clinics in shoulder and elbow

    2023  Volume 26, Issue 2, Page(s) 156–161

    Abstract: Background: We analyzed association between viewing two-dimensional computed tomography (2D CT) images in addition to radiographs with radial head treatment recommendations after accounting for patient and surgeon factors in a survey-based experiment.!## ...

    Abstract Background: We analyzed association between viewing two-dimensional computed tomography (2D CT) images in addition to radiographs with radial head treatment recommendations after accounting for patient and surgeon factors in a survey-based experiment.
    Methods: One hundred and fifty-four surgeons reviewed 15 patient scenarios with terrible triad fracture dislocations of the elbow. Surgeons were randomized to view either radiographs only or radiographs and 2D CT images. The scenarios randomized patient age, hand dominance, and occupation. For each scenario, surgeons were asked if they would recommend fixation or arthroplasty of the radial head. Multi-level logistic regression analysis identified variables associated with radial head treatment recommendations.
    Results: Reviewing 2D CT images in addition to radiographs had no statistical association with treatment recommendations. A higher likelihood of recommending prosthetic arthroplasty was associated with older patient age, patient occupation not requiring manual labor, surgeon practice location in the United States, practicing for five years or less, and the subspecialties "trauma" and "shoulder and elbow."
    Conclusions: The results of this study suggest that in terrible triad injuries, the imaging appearance of radial head fractures has no measurable influence on treatment recommendations. Personal surgeon factors and patient demographic characteristics may have a larger role in surgical decision making. Level of evidence: Level III, therapeutic case-control study.
    Language English
    Publishing date 2023-05-17
    Publishing country Korea (South)
    Document type Journal Article
    ZDB-ID 3031244-9
    ISSN 2288-8721 ; 2383-8337
    ISSN (online) 2288-8721
    ISSN 2383-8337
    DOI 10.5397/cise.2022.01368
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  2. Article: Increased Risk of Malignancy with Immunosuppression: A Population-Based Analysis of Texas Medicare Beneficiaries.

    Cicalese, Luca / Westra, Jordan R / O'Connor, Casey M / Kuo, Yong-Fang

    Cancers

    2023  Volume 15, Issue 12

    Abstract: Immunosuppressive drugs (IMD) are widely utilized to treat many autoimmune conditions and to prevent rejection in organ transplantation. Cancer has been associated with prolonged use of IMD in transplant patients. However, no detailed, systematic ... ...

    Abstract Immunosuppressive drugs (IMD) are widely utilized to treat many autoimmune conditions and to prevent rejection in organ transplantation. Cancer has been associated with prolonged use of IMD in transplant patients. However, no detailed, systematic analysis of the risk of cancer has been performed in patients receiving IMD for any condition and duration. We analyzed Medicare data from Texas Medicare beneficiaries, regardless of their age, between 2007 and 2018, from the Texas Cancer Registry. We analyzed the data for the risk of cancer after IMD use associated with demographic characteristics, clinical conditions, and subsequent cancer type. Of 29,196 patients who used IMD for a variety of indications, 5684 developed cancer. The risk of cancer (standardized incidence ratio) was particularly high for liver (9.10), skin (7.95), lymphoma (4.89), and kidney (4.39). Patients receiving IMD had a four fold greater likelihood of developing cancer than the general population. This risk was higher within the first 3 years of IMD utilization and in patients younger than 65 years and minorities. This study shows that patients receiving IMD for any indications have a significantly increased risk of cancer, even with short-term use. Caution is needed for IMD use; in addition, an aggressive neoplastic diagnostic screening is warranted.
    Language English
    Publishing date 2023-06-11
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2527080-1
    ISSN 2072-6694
    ISSN 2072-6694
    DOI 10.3390/cancers15123144
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  3. Article ; Online: Frailty is Associated With Increased Complication, Readmission, and Hospitalization Costs Following Primary Total Knee Arthroplasty.

    Lakra, Akshay / Tram, Michael K / Bernasek, Thomas L / Lyons, Steven T / O'Connor, Casey M

    The Journal of arthroplasty

    2023  Volume 38, Issue 7 Suppl 2, Page(s) S182–S186.e2

    Abstract: Background: Frailty has been associated with poor postoperative outcomes in various medical conditions and surgical procedures. However, the relationship between frailty and outcomes after primary total knee arthroplasty (TKA) has not been well- ... ...

    Abstract Background: Frailty has been associated with poor postoperative outcomes in various medical conditions and surgical procedures. However, the relationship between frailty and outcomes after primary total knee arthroplasty (TKA) has not been well-described. This study investigated the association of the Hospital Frailty Risk Score (HFRS) with postoperative events and hospitalization costs after primary TKA.
    Methods: Using a nationwide readmissions database, we identified 884,479 patients discharged after primary TKA for osteoarthritis between January 2017 and November 2019. HFRS was calculated for each patient to determine frailty status. We used multivariate logistic regressions to evaluate the association of frailty with 30-readmission rate and negative binomial regressions to evaluate lengths of hospital stay and hospitalization costs. The 30-day reoperation and complication rates were compared using chi-square tests.
    Results: Frailty was associated with increased odds of 30-day readmissions (odds ratio [OR]: 1.89, 95% confidence interval [CI]: 1.82-1.96), longer lengths of stay (OR: 1.43, 95% CI: 1.43-1.44), and higher hospitalization costs (OR: 1.16, 95% CI: 1.16-1.17). Frail patients also had significantly higher rates of 30-day reoperations (0.6 versus 0.4%), surgical complications (0.6 versus 0.4%), medical complications (3.4 versus 1.3%), and other complications (0.9 versus 0.5%) (P < .01).
    Conclusions: Frailty, as measured using HFRS, was associated with increased adverse events and health care burdens in patients undergoing TKA. The HFRS could be used to swiftly identify high-risk patients undergoing TKA and to potentially help optimize patients prior to elective TKA.
    Type of study: Level III retrospective cohort study.
    MeSH term(s) Humans ; Arthroplasty, Replacement, Knee/adverse effects ; Patient Readmission ; Retrospective Studies ; Frailty/complications ; Frailty/epidemiology ; Risk Factors ; Hospitalization ; Length of Stay ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology
    Language English
    Publishing date 2023-02-28
    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.2023.02.036
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    Zs.A 2134: Show issues Location:
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  4. Article: Misinformation in Patient Handouts About Upper Extremity Conditions.

    O'Connor, Casey M / Kortlever, Joost / Ring, David

    Journal of patient experience

    2020  Volume 7, Issue 6, Page(s) 1331–1335

    Abstract: This study investigated handouts regarding common upper extremity problems for inaccuracies, distracting information, and concepts that reinforce common unhelpful cognitive biases. We reviewed handouts on upper extremity conditions from 2 electronic ... ...

    Abstract This study investigated handouts regarding common upper extremity problems for inaccuracies, distracting information, and concepts that reinforce common unhelpful cognitive biases. We reviewed handouts on upper extremity conditions from 2 electronic medical records and 2 professional associations. We categorized information as inaccurate, distracting, and risk of reinforcing common unhelpful cognitive biases. Reading level, quality, and the ability of patients to process and take action was also rated. We found an average rate of inaccurate statements of 1.9 per 100 words, distracting statements of 0.73 per 100 words, and statements reinforcing common unhelpful cognitive biases of 2.1 per 100 words. Handouts from electronic medical records were rated higher quality and had higher reading grade level, but on average were constructed for better understandability. Patient handouts have a notable rate of inaccuracies, distractions, and information that may reinforce less adaptive cognitions. Greater attention is merited to making patient handouts readable, understandable, hopeful, and enabling.
    Language English
    Publishing date 2020-10-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2857285-3
    ISSN 2374-3743 ; 2374-3735
    ISSN (online) 2374-3743
    ISSN 2374-3735
    DOI 10.1177/2374373520966823
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  5. Article ; Online: Frailty Is Associated With Increased 30-Day Adverse Events and Hospitalization Costs After Primary Total Hip Arthroplasty.

    Tram, Michael K / O'Connor, Casey M / Qian, Alex S / Tram, Jennifer T / Tetreault, Matthew W

    The Journal of arthroplasty

    2022  Volume 37, Issue 8S, Page(s) S925–S930.e4

    Abstract: Background: Frailty can predict adverse outcomes for multiple medical conditions and surgeries but is not well studied in total hip arthroplasty (THA). We evaluate the association between Hospital Frailty Risk Score and postoperative events and costs ... ...

    Abstract Background: Frailty can predict adverse outcomes for multiple medical conditions and surgeries but is not well studied in total hip arthroplasty (THA). We evaluate the association between Hospital Frailty Risk Score and postoperative events and costs after primary THA.
    Methods: Using the National Readmissions Database, we identified primary THA patients for osteoarthritis, osteonecrosis, or hip fracture from January to November 2017. Using Hospital Frailty Risk Score, we compared 30-day readmission rate, hospital course duration, and costs between frail and nonfrail patients for each diagnosis, controlling for covariates. Thirty-day complication and reoperation rates were compared using univariate analysis.
    Results: We identified 167,700 THAs for osteoarthritis, 5353 for osteonecrosis, and 7246 for hip fractures. Frail patients had increased 30-day readmission rates (5.3% vs 2.5% for osteoarthritis, 7.1% vs 3.3% for osteonecrosis, 8.4% vs 4.3% for fracture; P < .01), longer hospital course (3.4 vs 1.9 days for osteoarthritis, 4.1 vs 2.1 days for osteonecrosis, 6.3 vs 3.9 days for fracture; P < .01), and increased costs ($18,712 vs $16,142 for osteoarthritis, $19,876 vs $16,060 for osteonecrosis, $22,185 vs $19,613 for fracture; P < .01). Frail osteoarthritis patients had higher 30-day complication (4.4% vs 1.9%; P < .01) and reoperation rates (1.6% vs 0.93%; P < .01). Frail osteonecrosis patients had higher 30-day complication rates (5.3% vs 2.6%; P < .01). Frail hip fracture patients had higher 30-day complication (6.6% vs 3.8%; P < .01) and reoperation rates (2.9% vs 1.8%; P < .01).
    Conclusion: Frailty is associated with increased healthcare burden and postoperative events after primary THA. Further research can identify high-risk patients and mitigate complications and costs.
    MeSH term(s) Arthroplasty, Replacement, Hip/adverse effects ; Fractures, Bone/surgery ; Frailty/complications ; Frailty/epidemiology ; Hospitalization ; Humans ; Osteoarthritis/surgery ; Osteonecrosis/surgery ; Patient Readmission ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Risk Factors
    Language English
    Publishing date 2022-01-25
    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.2022.01.047
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    Zs.A 2134: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  6. Article ; Online: Patient Frailty is Correlated With Increased Adverse Events and Costs After Revision Knee Arthroplasty.

    Kyaw, Nyi-Rein / Tram, Michael K / Lakra, Akshay / Bernasek, Thomas L / Lyons, Steven T / O'Connor, Casey M

    The Journal of arthroplasty

    2023  Volume 39, Issue 5, Page(s) 1165–1170.e3

    Abstract: Background: Frailty can predict adverse outcomes after various orthopaedic procedures, but is not well-studied in revision total knee arthroplasty (rTKA). We investigated the correlation between the Hospital Frailty Risk Score (HFRS) and post-rTKA ... ...

    Abstract Background: Frailty can predict adverse outcomes after various orthopaedic procedures, but is not well-studied in revision total knee arthroplasty (rTKA). We investigated the correlation between the Hospital Frailty Risk Score (HFRS) and post-rTKA outcomes.
    Methods: Using the Nationwide Readmissions Database, we identified rTKA patients discharged from January 2017 to November 2019 for the most common diagnoses (mechanical loosening, infection, and instability). Using HFRS, we compared 30-day readmission rate, length of stay, and hospitalization cost between frail and nonfrail patients with multivariate and binomial regressions. The 30-day complication and reoperation rates were compared using univariate analyses. We identified 25,177 mechanical loosening patients, 12,712 infection patients, and 9,458 instability patients.
    Results: Frail patients had higher rates of 30-day readmission (7.8 versus 3.7% for loosening, 13.5 versus 8.1% for infection, 8.7 versus 3.9% for instability; P < .01), longer length of stay (4.1 versus 2.4 days for loosening, 8.1 versus 4.4 days for infection, 4.9 versus 2.4 days for instability; P < .01), and greater cost ($32,082 versus $27,582 for loosening, $32,898 versus $28,115 for infection, $29,790 versus $24,164 for instability; P < .01). Frail loosening patients had higher 30-day complication (6.8 versus 2.9%, P < .01) and reoperation rates (1.8 versus 1.2%, P = .01). Frail infection patients had higher 30-day complication rates (14.0 versus 8.3%, P < .01). Frail instability patients had higher 30-day complication (8.0 versus 3.5%, P < .01) and reoperation rates (3.2 versus 1.6%, P < .01).
    Conclusions: The HFRS may identify patients at risk for adverse events and increased costs after rTKA. Further research is needed to determine causation and mitigate complications and costs.
    MeSH term(s) Humans ; Arthroplasty, Replacement, Knee/adverse effects ; Frailty/complications ; Frailty/epidemiology ; Hospitalization ; Patient Readmission ; Patient Discharge ; Retrospective Studies ; Reoperation/adverse effects
    Language English
    Publishing date 2023-12-20
    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.2023.12.025
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    Zs.A 2134: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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  7. Article ; Online: Patient Frailty is Correlated With Increased Adverse Events and Costs After Revision Total Hip Arthroplasty.

    Tram, Michael K / Tabbaa, Ameer / Lakra, Akshay / Anoushiravani, Afshin A / Bernasek, Thomas L / Lyons, Steven T / O'Connor, Casey M

    The Journal of arthroplasty

    2023  Volume 39, Issue 5, Page(s) 1151–1156.e4

    Abstract: Background: Frailty has been associated with poor outcomes and higher costs after primary total hip arthroplasty. However, frailty has not been studied in relation to outcomes after revision total hip arthroplasty (rTHA). This study examined the ... ...

    Abstract Background: Frailty has been associated with poor outcomes and higher costs after primary total hip arthroplasty. However, frailty has not been studied in relation to outcomes after revision total hip arthroplasty (rTHA). This study examined the relationship between the Hospital Frailty Risk Score (HFRS), postoperative outcomes, and cost profiles following rTHA.
    Methods: In this retrospective cohort study, we identified patients who underwent rTHA from January 2017 to November 2019 in the Nationwide Readmission Database. The 3 most frequently reported diagnosis codes for rTHA were then selected: dislocation; mechanical loosening; and infection. We calculated the HFRS for each patient to determine frailty status. We compared 30-day readmission rate, length of stay, and hospitalization cost between frail and nonfrail patients, using multivariate logistic and negative binomial regressions to adjust for covariates. We identified 36,243 total patients who underwent rTHA. Overall, 15,448 patients had a revision for dislocation, 11,062 for mechanical loosening, and 9,733 for infection.
    Results: Compared to nonfrail patients, frail patients had higher rates of 30-day readmission, longer length of stay, and higher hospitalization cost. Frail patients had significantly higher rates of 30-day complication and 30-day reoperation.
    Conclusions: Frailty, measured using HFRS, is associated with increased postoperative complications and costs after rTHA. The HFRS has the ability to efficiently identify frail patients at-risk for perioperative complications enabling care teams to better focus optimization interventions on this patient cohort.
    MeSH term(s) Humans ; Arthroplasty, Replacement, Hip/adverse effects ; Retrospective Studies ; Frailty/complications ; Frailty/epidemiology ; Reoperation/adverse effects ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Risk Factors
    Language English
    Publishing date 2023-12-21
    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.2023.12.027
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    Zs.A 2134: Show issues Location:
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  8. Article: Correlation of Single Assessment Numeric Evaluation (SANE) with other Patient Reported Outcome Measures (PROMs).

    O'Connor, Casey M / Ring, David

    The archives of bone and joint surgery

    2019  Volume 7, Issue 4, Page(s) 303–306

    Abstract: Background: The Single Assessment Numeric Evaluation (SANE) is a simple, one-question patient-reported outcome measure (PROM). We systematically reviewed correlations between SANE and more extensive PROMs.: Methods: We identified studies with ... ...

    Abstract Background: The Single Assessment Numeric Evaluation (SANE) is a simple, one-question patient-reported outcome measure (PROM). We systematically reviewed correlations between SANE and more extensive PROMs.
    Methods: We identified studies with correlation coefficients between SANE and other shoulder, knee, and ankle-specific PROMs. We calculated mean, median and range across studies and time points of data collection.
    Results: Eleven studies provided 14 correlations, six shoulder-specific PROMs in four studies, six knee-specific PROMs in six studies and two ankle specific PROMs in one study. The mean correlation comparing SANE and knee-specific PROMs was 0.60 (SD 0.24), median 0.66, and range 0.12 to 0.88. Among studies comparing SANE and shoulder-specific PROMs mean correlation was 0.59 (SD 0.20), median 0.62 and range 0.20 to 0.89. The mean correlation between SANE and ankle-specific PROMs was 0.69 (SD 0.17), median 0.69 and range 0.75 to 0.81.
    Conclusion: There seems to be moderate correlation amongst PROMs, even those that are a single question. Future research might address whether patient reported outcome measure a common underlying construct even when they consist of a single question.
    Language English
    Publishing date 2019-08-13
    Publishing country Iran
    Document type Journal Article ; Review
    ZDB-ID 2782053-1
    ISSN 2345-461X ; 2345-4644
    ISSN (online) 2345-461X
    ISSN 2345-4644
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  9. Article ; Online: Direct Anterior Approach Total Hip Arthroplasty Is Not Associated with Increased Infection Rates: A Systematic Review and Meta-Analysis.

    O'Connor, Casey M / Anoushiravani, Afshin A / Acosta, Ernesto / Davidovitch, Roy I / Tetreault, Matthew W

    JBJS reviews

    2021  Volume 9, Issue 1, Page(s) e20.00047

    Abstract: Background: The direct anterior approach (DAA) for primary total hip arthroplasty (THA) has recently increased in popularity. Recent evidence has raised concerns about whether use of the DAA is associated with increased rates of superficial and deep ... ...

    Abstract Background: The direct anterior approach (DAA) for primary total hip arthroplasty (THA) has recently increased in popularity. Recent evidence has raised concerns about whether use of the DAA is associated with increased rates of superficial and deep infection. The aim of this study was to systematically assess the literature and comparatively evaluate the rate of superficial and deep infection following primary THA using the DAA and non-direct anterior (non-DAA) approaches.
    Methods: This study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement. Primary outcome measures evaluated were rates of superficial and deep infection in patients undergoing DAA and non-DAA primary THA.
    Results: A total of 1,872 studies were identified in the original search, of which 15 studies satisfied inclusion criteria. Our analysis evaluated 120,910 primary THAs, including 14,908 DAA and 106,002 non-DAA. The rate of superficial infection was 1.08% for DAA compared with 1.24% for non-DAA (odds ratio [OR] = 1.01, 95% confidence interval [CI] = 0.79 to 1.30, p = 0.921). The rate of deep infection was 0.73% for DAA compared with 0.51% for non-DAA (OR = 1.03, 95% CI = 0.80 to 1.32, p = 0.831).
    Conclusions: This study found no difference in the rate of superficial or deep infection after primary THA using the DAA versus other surgical approaches. Our results suggest that comparative infection risk need not be a primary driver in the choice of surgical approach.
    Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
    MeSH term(s) Arthroplasty, Replacement, Hip/adverse effects ; Arthroplasty, Replacement, Hip/methods ; Humans
    Language English
    Publishing date 2021-01-26
    Publishing country United States
    Document type Journal Article ; Meta-Analysis ; Systematic Review
    ISSN 2329-9185
    ISSN (online) 2329-9185
    DOI 10.2106/JBJS.RVW.20.00047
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  10. Article ; Online: Conversion total hip arthroplasty following extracapsular hip fracture fixation with a cephalomedullary device: a comprehensive review.

    O'Connor, Casey M / Young, Joseph R / Villacres Mori, Benjamin / Murtaza, Hamza / Lyons, Steven T / Czajka, Cory / Bernasek, Thomas

    Archives of orthopaedic and trauma surgery

    2022  Volume 143, Issue 6, Page(s) 3525–3533

    Abstract: With the annual incidence of hip fractures and hip fracture fixation rising, the need for conversion total hip arthroplasty has also risen. About half of the 280,000 hip fractures that occur annually in the United States are extracapsular. Commonly ... ...

    Abstract With the annual incidence of hip fractures and hip fracture fixation rising, the need for conversion total hip arthroplasty has also risen. About half of the 280,000 hip fractures that occur annually in the United States are extracapsular. Commonly extracapsular hip fractures are treated with either cephalomedullary nails (CMNs) or sliding hip screws (SHS). More recently, there has been a shift toward increased CMN use due to increased training with this fixation method as well as perioperative and biomechanical benefits. Given this shift, orthopedic surgeons need to understand the factors that lead to CMN failure. Failed CMN treatment leaves both patients and surgeons with few management options including revision fixation with or without osteotomy, conversion total hip arthroplasty, and conversion hemiarthroplasty. Surgeons must consider the patient and injury characteristics before deciding the best treatment plan. Conversion total hip arthroplasty is indicated in younger patients without femoral head and/or acetabular articular injury, degenerative joint disease, or avascular necrosis. Conversion total arthroplasty is a technically demanding and resource-intensive surgery associated with lower success rates and outcomes than primary total hip arthroplasty. Orthopedic surgeons should have thorough understanding of preoperative workup needed prior to surgery, implant selection associated with best outcomes, most common surgical approaches used, intraoperative considerations, and complications associated with conversion total hip arthroplasty. A comprehensive understanding of these concepts gives patients the best chance of having a successful outcome.
    MeSH term(s) Humans ; Arthroplasty, Replacement, Hip ; Fracture Fixation, Internal ; Hip Fractures/surgery ; Fracture Fixation, Intramedullary ; Acetabulum/surgery
    Language English
    Publishing date 2022-08-20
    Publishing country Germany
    Document type Journal Article ; Review
    ZDB-ID 80407-1
    ISSN 1434-3916 ; 0003-9330 ; 0344-8444
    ISSN (online) 1434-3916
    ISSN 0003-9330 ; 0344-8444
    DOI 10.1007/s00402-022-04570-7
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