Implementation of a Perioperative Lung Protective Ventilation Protocol for Robotic-Assisted Surgeries.

This project sought to educate providers on the benefits of lung protective ventilation (LPV), implement a LPV protocol in robotic surgery, and evaluate adherence to the protocol in the adult (≥ 18 years) robotic-assisted surgery population. This project used a pre/post quality improvement design with a retrospective chart review and periodic knowledge, attitude, and practice surveys over the course of 6 months. This project retrospectively reviewed electronic medical records to assess adherence to the LPV protocol.

The Use of Critical Care Services After Orthopedic Surgery at a High-Volume Orthopedic Medical Center: A Retrospective Study.

With an aging population, orthopedics has become one of the largest and fastest growing surgical fields. However, data on the use of critical care services (CCS) in patients undergoing orthopedic procedures remain sparse. We sought to elucidate the prevalence and characteristics of patients requiring CCS and intermediate levels of care after orthopedic surgeries at a high-volume orthopedic medical center.

Tramadol prescribed at discharge is associated with lower odds of chronic opioid use after elective total joint arthroplasty.

Introduction: We aimed to study the association between tramadol prescribed at discharge (after elective total hip and knee arthroplasty (THA/TKA) surgery) and chronic opioid use postoperatively.

Methods: This retrospective cohort study queried the Truven MarketScan database and identified patients who underwent an elective THA/TKA surgery between 2016 and 2018 and were prescribed opioids at discharge (n=81 049). Multivariable analysis was conducted to study the association between tramadol prescription at discharge and chronic opioid use, with additional analysis adjusting for the amount of opioids prescribed in oral morphine equivalents.

Machine learning approaches in predicting ambulatory same day discharge patients after total hip arthroplasty.

Background: With continuing financial and regulatory pressures, practice of ambulatory total hip arthroplasty is increasing. However, studies focusing on selection of optimal candidates are burdened by limitations related to traditional statistical approaches. Hereby we aimed to apply machine learning algorithm to identify characteristics associated with optimal candidates.

Differential Perioperative Outcomes in Patients With Obstructive Sleep Apnea, Obesity, or a Combination of Both Undergoing Open Colectomy: A Population-Based Observational Study.

Background: An increasing body of evidence demonstrates an association between obstructive sleep apnea (OSA) and adverse perioperative outcomes. However, large-scale data on open colectomies are lacking. Moreover, the interaction of obesity with OSA is unknown.

Hip fracture characteristics and outcomes during COVID-19: a large retrospective national database review.

Background: The COVID-19 pandemic has impacted healthcare in various vulnerable patient subpopulations. However, data are lacking on the impact of COVID-19 on hip fractures, seen mainly in older patients. Using national claims data, we aimed to describe the epidemiology during the first COVID-19 wave in the USA.

The Impact of Immunization and Use of Oseltamivir on Influenza-Related Hospitalizations: A Population-Based Study.

Background: As the COVID-19 pandemic continues into flu season, it is critical to minimize hospitalizations to maximize capacity and preserve critical care resources. We sought to identify risk factors for influenza-related hospitalization, specifically the role of immunization and oseltamivir prescriptions.

Methods: Patients with influenza diagnoses were identified from the MarketScan database (2014-2018).

Association between sex and perioperative opioid prescribing for total joint arthroplasty: a retrospective population-based study.

Background: Scarce data exist on differential opioid prescribing between men and women in the pre-, peri-, and postoperative phases of care among patients undergoing total hip/knee arthroplasty (THA/TKA).

Methods: In this retrospective population-based study, Truven Health MarketScan claims data were used to establish differences between men and women in (1) opioid prescribing in the year before THA/TKA surgery, (2) the amount of opioids prescribed at discharge, and (3) chronic opioid prescribing (3-12 months after surgery). Multivariable regression models measured odds ratios (OR) with 95% confidence intervals (95% CI).

Persistent opioid use after surgical treatment of paediatric fracture.

Background: The opioid epidemic is one of the most pressing public health crises in the USA. With fractures being amongst the most common reasons for a child to require surgical intervention and receive post-surgical pain management, characterisation of opioid prescription patterns and risk factors is critical. We hypothesised that the numbers of paediatric patients receiving opioids, or who developed persistent opioid use, are significant, and a number of risk factors for persistent opioid use could be identified.

Machine Learning Approaches to Define Candidates for Ambulatory Single Level Laminectomy Surgery.

Study Design: retrospective cohort study.

Objectives: To test and compare 2 machine learning algorithms to define characteristics associated with candidates for ambulatory same day laminectomy surgery.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent single level laminectomy in 2017 and 2018.

The Utilization of Regional Anesthesia Among Pediatric Patients: A Retrospective Study.

Background: The use of regional anesthesia (RA) in pediatric patients remains understudied, although evidence suggests benefits over general anesthesia.

Questions/purposes: We sought to identify factors associated with RA use in patients under the age of 21 years undergoing ambulatory orthopedic surgery.

Methods: Patients under the age of 21 who underwent anterior cruciate ligament (ACL) repair or reconstruction, knee arthroscopy (KA), or shoulder arthroscopy (SA) were identified from the NY Statewide Planning and Research Cooperative System (SPARCS) database (2005-2015).

Venous thromboembolism and prophylaxis therapy after elective spine surgery: a population-based study.

Purpose: Currently, there is no generalized consensus regarding perioperative prophylaxis of venous thromboembolism (VTE) in patients undergoing spine surgery. In the absence of large-scale studies, we aimed to use national data to study the association between anticoagulant prophylaxis and VTE in spine surgical patients. Our secondary outcomes were hematoma and blood transfusion.

Bilateral Total Knee Arthroplasty and In-Hospital Opioid Dispension: A Population-Based Study.

Background: There is paucity of data regarding opioid dispension in patients undergoing bilateral total knee arthroplasty (BTKA). Our aim is to compare in-hospital opioid dispension between BTKA and unilateral TKA (UTKA) and to identify other factors associated with opioid dispension in the BTKA and UTKA cohorts.

Methods: Patients receiving elective TKA from 2006 to 2016 were retrospectively extracted from the Premier Healthcare Database.

Tranexamic acid administration during total joint arthroplasty surgery is not associated with an increased risk of perioperative seizures: a national database analysis.

Background: Tranexamic acid (TXA) has been used extensively to minimize blood loss in cardiac surgery and more recently in orthopedic surgery. Despite a generally good safety profile, an increased risk of seizures has been observed in patients with cardiac disease. However, this issue has not been adequately addressed in the orthopedic literature.

Increased Use of Intra-Articular Steroid Injection to Treat Osteoarthritis is Associated With Chronic Opioid Dependence After Later Total Knee Arthroplasty But Not Total Hip Arthroplasty.

Background: Intra-articular (IA) injections of corticosteroid (CO) and hyaluronic acid (HA) are commonly used for osteoarthritis. The efficacy of these interventions is controversial. Furthermore, research regarding the potential association of IA injection with later postoperative pain trajectories is lacking.