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INTRODUCTION: The Orthopaedic In-Training Examination (OITE) is a multiple-choice examination developed by the American Academy of Orthopaedic Surgeons annually since 1963 to assess orthopaedic residents' knowledge. This study's purpose is to analyze the 2017 to 2021 OITE trauma questions to aid orthopaedic residents preparing for the examination. METHODS: The 2017 to 2021 OITEs on American Academy of Orthopaedic Surgeons' ResStudy were retrospectively reviewed to identify trauma questions. Question topic, references, and images were analyzed. Two independent reviewers classified each question by taxonomy. RESULTS: Trauma represented 16.6% (204/1,229) of OITE questions. Forty-nine percent of trauma questions included images (100/204), 87.0% (87/100) of which contained radiographs. Each question averaged 2.4 references, of which 94.9% were peer-reviewed articles and 46.8% were published within 5 years of the respective OITE. The most common taxonomic classification was T1 (46.1%), followed by T3 (37.7%) and T2 (16.2%). DISCUSSION: Trauma represents a notable portion of the OITE. Prior OITE trauma analyses were published greater than 10 years ago. Since then, there has been an increase in questions with images and requiring higher cognitive processing. The Journal of Orthopaedic Trauma (24.7%), Journal of the American Academy of Orthopaedic Surgeons (10.1%), and Journal of Bone and Joint Surgery, American Volume (9.3%) remain the most cited sources.
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Internato e Residência , Ortopedia , Ortopedia/educação , Educação de Pós-Graduação em Medicina/métodos , Avaliação Educacional , Estudos RetrospectivosRESUMO
BACKGROUND: Uncontrolled hypertension (HTN) is a risk factor for mortality following elective surgery and poor hemodynamic control during total joint arthroplasty (TJA). However, the relationship between uncontrolled HTN and TJA outcomes remains poorly understood. The purpose of this study is to better define HTN parameters that are predictive of adverse arthroplasty outcomes. METHODS: This is a retrospective cohort analysis on patients who underwent primary TJA for osteoarthritis between 2017 and 2021 at a large orthopedic practice. Uncontrolled HTN was defined as a systolic blood pressure (SBP) > 140 mm Hg, or diastolic blood pressure (DBP) > 90 mm Hg. Spearman's rank correlations were used to evaluate relationships among uncontrolled HTN and operative duration, hemoglobin drop, allogenic transfusions, length of stay, intraoperative/postoperative complications, and readmissions. RESULTS: Four thousand three hundred forty-five patients met the selection criteria, of which 55.1% (N = 2394) presented with uncontrolled HTN. In total, 17.1% (N = 745) and 3.2% (N = 138) of patients had an SBP ≥ 160 and 180 mm Hg, respectively. In addition, 1.9% of patients (N = 84) presented with SBP ≥ 200 mm Hg (N = 13) and/or DBP ≥ 100 mm Hg (N = 71). Eight-four percent (N = 626) of patients who presented with SBP > 160 mm Hg had been preoperatively prescribed HTN control medications. Receiver operator curve analysis demonstrated poor predictive value of blood pressure for all aforementioned outcome variables. CONCLUSION: Our findings suggest that as defined, uncontrolled HTN is not an appropriate individual predictor of TJA outcomes and should not be used as a "hard stop" when determining eligibility for elective surgery. Further research utilizing a larger cohort is needed to define the relationship between HTN and TJA outcomes.
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Hipertensão , Artroplastia , Pressão Sanguínea , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: Patients presenting to an orthopedic clinic with joint pain often seek prior care and imaging before consultation. It is unknown how often orthopedic surgeons must repeat imaging and whether repeat imaging has an impact on diagnosis or management. The purpose of this study was to determine the frequency, reason, and impact of repeating radiographs in outpatient orthopedic clinics. METHODS: Patients ≥18 years of age presenting with hip and/or knee pain were prospectively enrolled at five arthroplasty clinics from January 2019 until June 2020. Before the initial visit, surveys were distributed to patients regarding the reason for their visit, prior care, and prior diagnostic imaging. At the conclusion of the visit, surgeons reported if repeat radiographs were obtained, and if so, surgeons documented the views ordered, the reasoning for new films, and if diagnosis or management changed as a result. Patients were grouped based on repeat imaging status, and of those with repeat imaging, subgroup analysis compared patients based on if management changed. RESULTS: Of 292 patients, 256 (88%) had radiographs before their office visit, and 167 (65%) obtained repeat radiographs. Radiographs were most commonly repeated if they were inaccessible (47%), followed by if they were non-weight-bearing (40%). Repeated radiographs changed the diagnosis in 40% of patients and changed management in 22% of patients. CONCLUSION: Most patients underwent repeat radiography at their orthopedic visit. The primary reasons were owing to accessibility or the patient being non-weight-bearing. Repeat radiographs changed management in almost one-quarter of patients.
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Artroplastia do Joelho , Articulação do Joelho , Artralgia , Artroplastia do Joelho/efeitos adversos , Humanos , Joelho , RadiografiaRESUMO
BACKGROUND: Medically complex patients require more resources and experience higher costs within total joint arthroplasty (TJA) bundled payment models. While risk adjustment would be beneficial for such patients, no tool currently exists which can reliably identify these patients preoperatively. The purpose of this study is to determine if the Hospital Frailty Risk Score (HFRS) is a valid predictor of high-TJA treatment costs. METHODS: Retrospective analysis was performed on patients who underwent primary TJA between 2015 and 2020 from a single large orthopedic practice. ICD-10 codes from an institutional database were used to calculate HFRS. Cost data including inpatient, postacute, and episode of care (EOC) costs were collected. Charlson comorbidity index, demographics, readmissions, and complications were analyzed. RESULTS: 4936 patients had a calculable HFRS and those with intermediate and high scores experienced more frequent readmissions/complications after TJA, as well as higher EOC costs. However, HFRS did not reliably predict EOC costs, yielding a sensitivity of 49% and specificity of 66%. Multivariate analysis revealed that both patient age and sex are superior individual cost predictors when compared with HFRS. Secondary analyses indicated that HFRS more effectively predicts TJA complications and readmissions but is still nonideal for clinical applications. CONCLUSION: HFRS has poor sensitivity as a predictor of high-EOC costs for TJA patients but has adequate specificity for predicting postoperative readmissions and complications. Further research is needed to develop a scale that can appropriately predict orthopedic cost outcomes.
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Artroplastia de Quadril , Artroplastia do Joelho , Fragilidade , Pacotes de Assistência ao Paciente , Idoso , Custos de Cuidados de Saúde , Hospitais , Humanos , Medicare , Readmissão do Paciente , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Traditional pain management after total knee arthroplasty (TKA) relies heavily on opioids. Although there is evidence that in-hospital multimodal pain management (MMPM) is more effective than opioid-only (OO) analgesia, there has been little focus on postdischarge pain management. The hypothesis of this study was that MMPM after TKA would reduce pain scores and opioid consumption in the 30-day period after hospital discharge. METHODS: This is a prospective, 2-group, comparative study with a provider cross-over design comparing a 30-day OO prn regimen with a MMPM regimen and opioid medications prn. The primary outcome measure was visual analog scale pain score and opioid-related side effects. Secondary outcome measures included morphine milligram equivalents consumed, failure of the protocol, and opioid refills. RESULTS: There were 216 patients included in the trial, with final data available for 143. There was no clinically meaningful difference in visual analog scale score between the 2 groups at any time. Average opioid consumption at 30 days was 582.5 and 386.4 morphine milligram equivalents for the OO and MMPM cohorts, respectively (P = .0006). Average number of opioid pills consumed at 30 days was 91.8 and 60.4 for OO and MMPM cohorts, respectively (P = .0004). CONCLUSION: A 30-day postdischarge multimodal pain regimen reduced opioid use after TKA while maintaining a similar level of pain control as the OO regimen. OO regimens are at an increased risk of needing additional medications to control pain. LEVEL OF EVIDENCE: Level II. REGISTRY NAME: www.clinicaltrials.gov. TRIAL NUMBER: NCT04003350.