Patient- and Procedure-Specific Variables Associated With Removal or Revision of Radial Head Arthroplasty.

Introduction The purpose of this retrospective review was to identify risk factors associated with removal or revision following radial head arthroplasty. Methods Patients undergoing primary radial head arthroplasty between 2009 and 2015 with a minimum follow-up of 1 year were identified. Descriptive and bivariate statistics were used to analyze the characteristics of patients requiring implant removal or revision and multivariable analysis was performed to calculate hazard ratios.

Comparison of coronary revascularization strategies in older adults presenting with acute coronary syndromes.

Background: The optimal coronary revascularization strategy to maximize the patient-centered outcome of days alive and out of hospital (DAOH), in multimorbid older (≥65-years) adults after an acute coronary syndrome (ACS) is incompletely understood.

Methods: Using Kaiser Permanente Northern California Health Plan databases, we identified 3871 patients ≥65-years presenting with ACS between 1/1/2010-3/1/2018 who underwent coronary revascularization with either coronary artery bypass grafting (CABG, N = 1575) or multivessel percutaneous coronary intervention (PCI, N = 2296). Selection bias was accounted for through propensity score modeling techniques and inverse probability of treatment weighting.

Increased Rates of Obstetric Complications Prior to Systemic Sclerosis Diagnosis.

Objective: To investigate whether obstetric complications prior to systemic sclerosis (SSc) diagnosis are more common in SSc patients compared to the general obstetric population.

Methods: A case-control study was performed at Kaiser Permanente Northern California to compare prior obstetric complications in adult women who later developed SSc (cases) with women from the general obstetric population who did not develop SSc (controls; matched 10:1 by age and year of delivery) from 2007 to 2016. Exposures included past hypertensive disorders of pregnancy (preeclampsia, eclampsia, gestational hypertension), premature rupture of membranes (PROM), intrauterine growth restriction (IUGR), maternal infections, neonatal intensive care unit (NICU) admission, and preterm birth.

The Correlation of the Trans-Atlantic Inter-Society Consensus Classification to Outcomes of Pedal Amputations.

In an attempt at limb salvage for patients with peripheral arterial disease, revascularization is often performed prior to pedal amputation. The purpose of this study was to evaluate the association between proximal arterial lesions, based on Trans-Atlantic Inter-Society Consensus aortoiliac, femoropopliteal, and infrapopliteal classifications, and healing pedal amputations post endovascular revascularization. Patients with revascularization up to 90 days prior to pedal amputation with a minimum of 12 months postoperative follow-up were included.

Variation in physician-directed immunohistochemistry screening among women with endometrial cancer.

Objective: Immunohistochemistry screening is a reliable method for identifying women with endometrial cancer who are at risk for Lynch syndrome, but clinical workflows used to implement immunohistochemistry screening protocols can vary by institution. The goal of this study was to investigate variation in performance of immunohistochemistry screening when a physician order is required.

Methods: Retrospective study from an integrated healthcare system with a risk-based immunohistochemistry screening policy for Lynch syndrome from January 2015 to December 2016.

Risk of Non-Melanoma Skin Cancer in Connective Tissue Disease and The Impact of Immunosuppressive Therapy.

The risk of skin cancer in connective tissue disease and the impact of immunosuppressive therapy on this risk has not been well studied. The objective of this study is to investigate the risk of non-melanoma skin cancer in patients with connective tissue disease and to assess the impact of immunosuppressive therapy on this risk. This is a retrospective case control cohort study of 8281 patients with connective tissue disease (systemic lupus erythematosus, Sjogren’s disease and scleroderma) and 8281 age, race, and gender matched controls followed for a 5-year period between 2002-2012, who obtained their care from a large integrated multispecialty group practice in Northern California.

The Effects of Endovascular Timing and In-line Flow on the Success of Pedal Amputations.

There has been a growing trend toward endovascular intervention to improve peripheral flow in patients with peripheral arterial disease. To date, there is no clear consensus regarding timing of lower-extremity amputations after revascularization. The purpose of this study was to evaluate the effects of timing between endovascular intervention and minor lower-extremity amputations and its influence on wound healing and limb loss within 1 year.

Comparison of two Lynch screening strategies in endometrial cancer in a California health system.

Objective: Compare detection of Lynch syndrome in endometrial cancer between regions of a health care system with different screening strategies.

Methods: A retrospective study of endometrial cancer (EC) cases from 2 regions of an integrated health care system (Kaiser Permanente Northern (KPNC) and Southern (KPSC) California). Within KPNC, immunohistochemistry tumor screening (IHC) was physician ordered and risk-based; within KPSC, IHC was universal and automated.

Increased Mortality in Asians With Systemic Sclerosis in Northern California.

Objective: The objective of this study is to evaluate racial/ethnic differences in disease manifestations and survival in a US cohort of patients with systemic sclerosis (SSc), with a focus on Asian patients.

Methods: A retrospective cohort study was conducted among Kaiser Permanente Northern California adults with an incident SSc diagnosis by a rheumatologist from 2007 to 2016, confirmed by a chart review to fulfill 2013 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria. Self-reported race/ethnicity was categorized as non-Hispanic white, Asian, Hispanic, and black.