Ambulatory discharge of patients undergoing sleeve gastrectomy results in significantly more adverse outcomes.

Background: Same-day discharge after sleeve gastrectomy (SDSG) has become more common during the COVID pandemic. Several payers have suggested that they would no longer reimburse for planned inpatient hospital stay for patients undergoing SG. The goal of our study was to determine which, if any, patient groups could safely undergo SDSG.

Effects of glucagon-like peptide-1 receptor agonists on upper endoscopy in diabetic and nondiabetic patients.

Background And Aims: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) promote weight loss by suppressing appetite, enhancing satiety, regulating glucose metabolism, and delaying gastric motility. We sought to determine whether GLP-1 RA use could affect medical procedures such as EGD.

Methods: We conducted a retrospective study of 35,183 patients who underwent EGD between 2019 and 2023, 922 of whom were using a GLP-1 RAs.

Older age and smaller joint space width are associated with conversion to total hip arthroplasty following hip arthroscopy.

Purpose: The goal of this study was to define the outcomes of patients following hip arthroscopy and to identify potential factors, found during hip arthroscopy, that were associated with patients' eventual conversion to total hip arthroplasty (THA).

Methods: Patients who had undergone hip arthroscopy from January 2010 to January 2015 were retrospectively reviewed and patients were reported if they had a THA in the same hip. Patients were followed up to December 2022 resulting in between 7 and 12 years of follow-up.

Genome-first approach of the prevalence and cancer phenotypes of pathogenic or likely pathogenic germline TP53 variants.

Pathogenic or likely pathogenic (P/LP) germline TP53 variants are the primary cause of Li-Fraumeni syndrome (LFS), a hereditary cancer predisposition disorder characterized by early-onset cancers. The population prevalence of P/LP germline TP53 variants is estimated to be approximately one in every 3,500 to 20,000 individuals. However, these estimates are likely impacted by ascertainment biases and lack of clinical and genetic data to account for potential confounding factors, such as clonal hematopoiesis.

Bilateral Tibial Tubercle Avulsion Fractures With an Associated Patellar Tendon Avulsion in an Adolescent Patient.

Tibial tubercle fractures in pediatric patients are increasing in frequency as more children participate in sports. These injuries are often seen in boys engaging in jumping activities before closure of their proximal tibial physis. Bilateral tibial tubercle fractures have been reported in the literature, but less frequent are associated patellar tendon ruptures with fracture of the tubercle.

Arm Health in Elite Collegiate Summer League Baseball Players Assessed by the Kerlan-Jobe Orthopaedic Clinic Score.

Context: Collegiate baseball players with professional aspirations often participate in summer leagues; foremost among them is the Cape Cod Baseball League (CCBL). Injuries acquired during the collegiate baseball season can be carried into the CCBL season and vice versa.

Objective: To assess the history of throwing arm injury and current functionality in midseason CCBL players.

The Effect of Surgical Approach on the Outcomes of Same-Day Discharge Outpatient Total Hip Arthroplasty at a Single Ambulatory Surgery Center.

Background: Primary total hip arthroplasty (THA) is increasingly being performed in the outpatient setting. However, there is little known regarding the differences in same-day discharge (SDD) rates and complications of operative approach in same-day total hip arthroplasty in the ambulatory surgery center (ASC) setting.

Methods: A retrospective chart review was performed between July 2019 and October 2021 for all patients who underwent primary THA in a single freestanding ASC.

Differences in the Medical Advisability of Online Pitching Recommendations for Youth Softball Players Based on Website Source.

Background: Guidelines regarding injury prevention in fast-pitch softball pitchers have yet to be widely adopted, risking the online dissemination of misleading advice.

Purpose/hypothesis: The purpose of this study was to assess the source and medical advisability of online pitching recommendations for youth softball players and highlight the risk of misinformation. It was hypothesized that many popular websites would contain content discordant with current medical guidelines regarding windmill softball pitching recommendations.

The Correlation of Thyroid Hormone Levels and Anti-Thyroidal Drugs on Thyroid Size, Weight, and Ease of Surgical Dissection for Thyroidectomy for Graves' Disease.

Background: Patients with Graves' Disease often have a larger thyroid size than patients without thyroid disease. These patients also have elevated T3 and T4 with decreased TSH.

Purpose: We evaluate whether these thyroid labs, the use of antithyroid agents, or the size of a thyroid on ultrasound, correlate with the pathological size of a thyroid in patients who undergo total thyroidectomy for Graves' Disease.

Resilience in Residency and Beyond.

» Distinct from the burnout and wellness continuum, resilience is a developed and refined characteristic that propels an individual toward personal and professional success.» We propose a clinical resilience triangle consisting of 3 components that define resilience: grit, competence, and hope.» Resilience is a dynamic trait that should be built during residency and constantly fortified in independent practice so that orthopaedic surgeons may acquire and hone the skills and mental fortitude required to take on the overwhelming challenges that we all inevitably face.

Clinical significance of iron deficiency among candidates for metabolic surgery.

Background: Iron deficiency (ID), a known complication after metabolic surgery, is common among preoperative patients in the presence of inflammation. Evidence is now accumulating that preoperative ID may adversely affect perioperative outcomes.

Objectives: To investigate the relationship between preoperative iron status and the risk of postoperative severe anemia.

Lack of Consensus in Rehabilitation Protocols After Posterior Shoulder Stabilization.

Background: Posterior shoulder instability is being identified and treated more frequently by orthopaedic providers. After posterior shoulder stabilization, long-term outcomes in function and mobility are largely dependent on the postoperative rehabilitation period. Thus, it is important to assess the consistency between protocols at different institutions.

Prior metabolic surgery reduced COVID-19 severity: Systematic analysis from year one of the COVID-19 pandemic.

Background: Obesity is a risk factor for COVID-19 severity. Recent studies suggest that prior metabolic surgery (MS) modifies the risk of COVID-19 severity.

Methods: COVID-19 outcomes were compared between patients with MS (n = 287) and a matched cohort of unoperated patients (n = 861).

A Review of Abductor Tendon Tears: The Hidden Lesion of the Hip.

»: Greater trochanteric pain syndrome consists of a group of associated conditions involving the lateral hip that can be debilitating to patients, mostly women between ages 40 and 60 years.

»: Abductor tendon tears are becoming a more recognized cause of lateral hip pain in patients without hip osteoarthritis.

»: Diagnosis of this condition is critical to patient care because misdiagnosis often leads to unnecessary prolonged pain and even unnecessary procedures that address different pathologies.

Is Robotic Revisional Bariatric Surgery Justified? An MBSAQIP Analysis.

Background: The laparoscopic approach is utilized in greater than 90% of bariatric surgeries. With the growing prevalence of robotic-assisted surgery in bariatrics, there has been limited consensus on the superiority of either laparoscopic or robotic approaches, especially in revisional procedures (conversion from sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB)).

Methods: A retrospective analysis was performed of the MBSAQIP PUF database of patients who underwent conversion from SG to RYGB procedures in either laparoscopic or robotic-assisted approaches.

Large Angiolipoma of the Hand as a Cause for Carpal Tunnel Syndrome.

Angiolipomas of the hand and wrist are rare presentations with only a few case reports in the literature. These subtypes of lipomas can be infiltrating or noninfiltrating, often affecting treatment outcomes and strategies. Angiolipomas can present as tender masses and, on average, will appear much larger than simple lipomas.

Stratified Preoperative A1c is not Significantly Associated With Clavien-Dindo Major Complications Following Bariatric Surgery in the MBSAQIP Database.

Background: Type 2 Diabetes Mellitus (T2DM) is highly prevalent comorbidity in patients with morbid obesity. It is still unclear whether a cutoff value of preoperative A1c represents an increased risk for major postoperative complications following Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG).

Methods: Retrospective MBSAQIP Participant Use File cohort for both years 2017 and 2018 were analyzed to evaluate the relationship between HbA1c in patients with morbid obesity and T2DM undergoing bariatric surgery, and the 30 days postoperative major complications by Clavien-Dindo classification (III/IV).

Effects of sustained weight loss on outcomes associated with obesity comorbidities and healthcare resource utilization.

Objective: Determine the impact of long-term non-surgical weight loss maintenance on clinical relevance for osteoarthritis, cancer, opioid use, and depression/anxiety and healthcare resource utilization.

Methods: A cohort of adults receiving primary care within Geisinger Health System between 2001-2017 was retrospectively studied. Patients with ≥3 weight measurements in the two-year index period and obesity at baseline (BMI ≥30 kg/m2) were categorized: Obesity Maintainers (reference group) maintained weight within +/-3%; Weight Loss Rebounders lost ≥5% body weight in year one, regaining ≥20% of weight loss in year two; Weight Loss Maintainers lost ≥5% body weight in year one, maintaining ≥80% of weight loss.

Impact of Sustained Weight Loss on Cardiometabolic Outcomes.

Obesity increases the risk of developing type 2 diabetes, hypertension, and hyperlipidemia. We sought to determine the impact of obesity maintenance, weight regain, weight loss maintenance, and magnitudes of weight loss on future risk and time to developing these cardiometabolic conditions. This was a retrospective cohort study of adults receiving primary care at Geisinger Health System between 2001 and 2017.

Rates of and Risk Factors for Trigger Finger after Open Carpal Tunnel Release.

 We have anecdotally noticed a higher rate of trigger fingers (TFs) developing in patients who have undergone carpal tunnel release (CTR).  Is the rate of TFs after CTR greater compared to the nonoperative hand? Is the thumb more commonly involved postoperatively compared with spontaneous TFs? Do particular associated comorbidities increase this risk?  We queried our institutional database for patients who had undergone open CTR during a 2-year period and recorded the development of an ipsilateral TF after a CTR or a contralateral TF in the nonoperative hand. Patient demographics, comorbidities, concurrent initial procedures, time to diagnosis, and finger involvement were recorded.

Medical Advisability of Youth Pitching Recommendations on the Internet.

Background: As the incidence of youth pitching injuries and surgical procedures attributed to overuse has drastically increased, there are quality concerns about popular internet resources regarding arm care for youth pitchers.

Purpose/hypothesis: To assess the medical advisability of online arm care recommendations for youth pitchers. It was hypothesized that websites contain misleading arm-care information that is discordant with medical advice.

Post-Discharge Outcomes After Pancreatic Necrosectomy: A Single Institution Experience Following Endoscopic vs Open Debridement.

Background: Pancreatic necrosectomy outcomes have been studied extensively; however, long-term results of these procedures have not been well characterized. Our study aimed to assess the outcomes at and after discharge for patients following necrosectomy.

Methods: Data from patients undergoing pancreatic necrosectomy at a single tertiary referral hospital from January 1, 2007, to June 1, 2019 were retrospectively analyzed.