Publications by authors named "Jessica Schmerler"
Introduction: Medical school curricula offer limited exposure to orthopaedic surgery, and few national initiatives aim to prepare students for orthopaedic surgery subinternships, which are critical for success in matching into orthopaedic residency. In this study, we evaluated the effectiveness of a single-day virtual "Subinternship Summit" for medical students in 2 key areas: 1) enhancing participants' confidence in their preparedness for orthopaedic subinternship rotations and 2) mitigating any disparities based on student characteristics, such as race/ethnicity, gender, or whether or not the student's school is affiliated with a "home" orthopaedic program.
Methods: In March 2024, a single-day national virtual summit was held, featuring panels on topics relevant to performance during orthopaedic subinternships.
Introduction: Orthopaedic surgery has the greatest degree of gender disparity among all medical specialties, presenting a little-explored opportunity to recruit women into orthopaedics early in the pipeline, particularly as undergraduate students. This study aimed to characterize the opinions of female premedical students regarding orthopaedic surgery as well as to assess the effectiveness of a virtual intervention in increasing interest in or improving attitudes toward the field.
Methods: In this prospective study, recruitment emails were sent to premedical advisors, who then circulated a survey that solicited responses from female-identifying premedical students.
Payer Status and Racial Disparities in Time to Surgery for Emergent Orthopaedic Procedures.
J Am Acad Orthop Surg
November 2024
Introduction: Delay in surgical management for orthopaedic emergencies and severe fracture types can result in notable morbidity and even mortality for patients. Disparities in various facets of orthopaedic care have been identified based on race/ethnicity, socioeconomic status, and payer status, but disparities in time to surgery have been poorly explored. The purpose of this study was, therefore, to investigate whether disparities exist in time to emergent orthopaedic surgery.
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- Recent advancements in blood management techniques, including the use of tranexamic acid, have led to a significant decrease in transfusion rates following total knee arthroplasty (TKA).
- A study analyzed data from over 500,000 TKA patients between 2010 and 2021, revealing that the rate of transfusion dropped from 10.6% to 0.6%, while the impact of preoperative anemia on transfusion risk increased significantly.
- The findings suggest that focusing on preoperative anemia could be crucial to further reducing transfusion needs as blood management protocols continue to improve.
Article Synopsis
- Obesity negatively affects outcomes of total hip arthroplasty (THA), prompting surgeons to set body mass index limits and recommend preoperative weight loss for patients.
- A study analyzed THA patients from 2013-2020 to see if losing over 10% of body weight before surgery improved their postoperative results, adjusting for various patient factors.
- Findings showed that significant preoperative weight loss led to longer hospital stays and higher rates of complications for both general and obese patients, indicating that rapid weight loss may not be beneficial and could worsen outcomes.
Study Design: Retrospective review.
Objectives: We substratified the mFI-5 frailty index to reflect controlled and uncontrolled conditions and assess their relationship to perioperative complications.
Summary Of Background Data: Risk assessment before adult spinal deformity (ASD) surgery is critical because the surgery is highly invasive with a high complication rate.
Article Synopsis
- A retrospective study investigated the link between the AM-PAC "6-Clicks" score and postoperative ileus development in patients undergoing adult spinal deformity (ASD) surgery, noting a high complication rate in such procedures.
- Out of 85 surgeries analyzed, 12% of patients developed ileus, typically around postoperative day 3, and those with a first AM-PAC score below 13 were significantly more likely to experience this complication.
- The findings suggest that an initial AM-PAC score under 13, indicating poor mobility, may help identify patients at increased risk for ileus post-surgery, emphasizing the importance of mobility for recovery.
Elastic stable intramedullary nailing (ESIN) has been shown to be an effective form of surgical management for lower-extremity diametaphyseal fractures in pediatric patients, but studies are limited because ESIN treatment for these fractures is relatively uncommon. We sought to determine whether ESIN can be used effectively in the most distal or proximal short-segment forms of these fractures. We queried the electronic medical record system at Johns Hopkins Hospital using Current Procedural Terminology codes for femur and tibia fractures treated with ESIN in patients under 18 years old between January 2015 and October 2022.
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- The study analyzes the reasons for revision total hip arthroplasty (rTHA) across different body mass index (BMI) classes using data from nearly 100,000 patients between 2006 and 2020.
- Researchers found that underweight patients had a higher likelihood of revisions due to dislocation and periprosthetic fractures, while overweight and obese patients were more prone to infections.
- The findings suggest that understanding these differences in reasons for rTHA can help tailor patient care to minimize complications based on BMI.
Background: Lisfranc fracture-dislocation is an uncommon but serious injury that currently lacks universal consensus on optimal operative treatment. Two common fixation methods are open reduction and internal fixation (ORIF) and primary arthrodesis (PA). The objective of this study is to analyze the cost difference between ORIF and PA of Lisfranc injuries, along with the contribution of medical services to overall costs.
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- - The study investigates the impact of preoperative anemia on complications following open reduction internal fixation (ORIF) of distal radius fractures, revealing that higher severity of anemia correlates with worse postoperative outcomes.
- - A total of 14,136 patients were analyzed, finding that mildly anemic individuals had longer hospital stays and greater chances of readmission and sepsis, while moderately to severely anemic patients faced even more severe complications like septic shock and postoperative transfusions.
- - The findings suggest that surgeons should routinely check for preoperative anemia and try to address it before surgery, or provide appropriate management and education afterward to mitigate risks.
Article Synopsis
- * The study analyzed data from 2,340 patients through propensity score matching to compare outcomes between COVID-19-positive and negative patients post-surgery.
- * Understanding these complications can help orthopedic surgeons provide better guidance and risk mitigation strategies for patients, especially those in higher risk categories.
Article Synopsis
- The study investigates the impact of social determinants of health disparities (SDHD) on postoperative complications after total knee arthroplasty (TKA) using a national insurance claims database from 2010 to 2019.
- A retrospective analysis identified patients with and without SDHD, matching them on key demographic and health factors to assess complications within 90 days and 2 years post-surgery.
- Results indicate that patients with SDHD had significantly higher odds of readmissions, medical complications, revision surgeries, and joint infections, confirming that SDHD is an independent risk factor for poorer surgical outcomes.
Article Synopsis
- - Total ankle arthroplasty (TAA) is becoming more popular than ankle arthrodesis for treating ankle osteoarthritis, but disparities in who receives these procedures are not well understood.
- - The study identified racial/ethnic and socioeconomic factors affecting patients' likelihood of getting TAA versus arthrodesis, finding that Black and Asian patients were significantly less likely to receive TAA than White patients.
- - Higher-income patients and those with private or Medicare insurance were more likely to undergo TAA compared to lower-income patients and those on Medicaid, indicating substantial disparities tied to race, income, and insurance status.
Article Synopsis
- The study aims to explore the link between eating disorders, specifically anorexia nervosa and bulimia nervosa, and the risk of lower extremity soft tissue injuries and surgeries.
- Researchers identified patients with these disorders from 2010-2020 using specific medical coding databases, comparing them to control groups without eating disorders to analyze injury prevalence.
- Results showed that both eating disorders significantly increased the prevalence of knee and ankle injuries, as well as surgical interventions, with patients suffering from bulimia experiencing higher rates of certain ligament injuries compared to those with anorexia.
Article Synopsis
- The study investigates whether patients with eating disorders like anorexia nervosa and bulimia nervosa are at a higher risk for upper extremity soft tissue injuries and surgeries due to nutritional deficiencies and other musculoskeletal issues.
- Researchers used a national claims database from 2010-2021 to compare patients with these eating disorders to matched control groups without them, analyzing the incidence of injuries and surgeries through medical coding systems.
- Results showed that patients with eating disorders were significantly more likely to experience various types of shoulder and upper extremity injuries, and they also faced increased rates of specific surgeries, indicating a clear link between eating disorders and upper extremity injuries.
Article Synopsis
- Body mass index (BMI) influences the risk and causes of revision total knee arthroplasty (rTKA), with different BMI classes showing varied likelihoods for specific causes of revision.
- A study analyzing 171,856 rTKA patients found that underweight individuals were less likely to have revisions due to mechanical issues but more likely due to infections and fractures, while overweight and morbidly obese patients showed increased risks for mechanical-related causes.
- Understanding these differences can help tailor patient management strategies to reduce complications in rTKA based on their BMI category.
Article Synopsis
- Mental health conditions have gained increased attention in the field of orthopaedic surgery, especially during the COVID-19 pandemic, affecting both patients and surgeons.
- A systematic review of studies from 2001 to 2022 identified 416 relevant publications, revealing significant growth over the years, with 88% focusing on patients and only 10% on surgeons' mental health.
- Notably, productive subspecialties included arthroplasty, general orthopaedics, and spine, while certain mental illnesses like schizophrenia and bipolar disorder were underrepresented in the published research.
Introduction: Data regarding racial/ethnic and socioeconomic differences in revision total hip arthroplasty (rTHA) and revision total knee arthroplasty (rTKA) have been inconsistent. This study examined racial/ethnic and socioeconomic disparities in comorbidity-adjusted risk and reason for rTHA and rTKA.
Methods: Patients who underwent rTHA or rTKA between 2006 and 2014 in the National Inpatient Sample were identified.
Article Synopsis
- A study evaluated the quality of YouTube videos on trigger finger release surgery, highlighting the importance of credible healthcare information amid the lack of regulation on the platform.* -
- The analysis found that videos created by physicians scored significantly higher for quality and informational content compared to those by non-physicians, indicating that physician videos provide more reliable information for patients.* -
- Key shortcomings identified in all videos included inadequate discussion of surgical risks, uncertainties, the diagnostic process, and non-surgical prognosis, with a low focus on providing complete patient information.*
Article Synopsis
- A study was conducted to identify preoperative characteristics linked to low early postoperative mobility (LEPOM) in adult spinal deformity (ASD) patients, as LEPOM is connected to longer hospital stays and more complications.
- The sample included 86 patients undergoing spinal fusion, with LEPOM defined by a low AM-PAC score indicative of mobility issues post-surgery.
- Significant preoperative factors associated with LEPOM included high pain and anxiety scores, low physical function scores, a high Oswestry disability index, a high body mass index, and being male, with varying odds ratios indicating their level of risk.
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- An 81-year-old woman experienced severe hypercalcemia after undergoing hip surgery that involved calcium sulfate beads, leading to a stay in the intensive care unit.
- Her calcium levels reached a dangerously high point of 21.0 mg/dL, which resulted in acute encephalopathy (a serious brain condition).
- Fortunately, after receiving treatments like calcitonin and bisphosphonates, her calcium levels returned to normal, and her mental status improved, highlighting the need to be cautious with calcium sulfate use in orthopedic procedures.