Predictors of hospital readmission following revision total knee arthroplasty.

Purpose: Hospital readmission is emerging as an important quality measure, yet modifiable predictors of readmission remain unknown. This study was designed to identify risk factors for readmission following revision total knee arthroplasty.

Methods: The National Surgical Quality Improvement Program dataset was queried to identify patients undergoing revision total knee arthroplasty from 2011 to 2012.

Arthroscopic Shoulder Surgical Simulation Training Curriculum: Transfer Reliability and Maintenance of Skill Over Time.

Background: Surgical education is evolving as work hour constraints limit the exposure of residents to the operating room. Potential consequences may include erosion of resident education and decreased quality of patient care. Surgical simulation training has become a focus of study in an effort to counter these challenges.

MEASUREMENT: ACCOUNTING FOR RELIABILITY IN PERFORMANCE ESTIMATES.

When evaluating physician performance measures, physician leaders are faced with the quandary of determining whether departures from expected physician performance measurements represent a true signal or random error. This uncertainty impedes the physician leader's ability and confidence to take appropriate performance improvement actions based on physician performance measurements. Incorporating reliability adjustment into physician performance measurement is a valuable way of reducing the impact of random error in the measurements, such as those caused by small sample sizes.

Surgical Techniques for the Reconstruction of Medial Collateral Ligament and Posteromedial Corner Injuries of the Knee: A Systematic Review.

Purpose: To systematically review reconstruction techniques of the medial collateral ligament (MCL) and associated medial structures of the knee (e.g., posterior oblique ligament).

Evaluation of Evidence for Acne Remission With Oral Isotretinoin Cumulative Dosing of 120-150 mg/kg.

Background: Oral isotretinoin (ISO) is the standard of care for severe inflammatory acne and a threshold dose of 120-150 mg/kg is widely regarded as increasing remission potential.

Objective: Our objective was to evaluate the evidence underlying ISO dosing of 120-150 mg/kg in acne remission.

Methods: A systematic literature search was performed using keywords "acne," "isotretinoin," "efficacy," "dosing," "relapse," and "remission.

Incidence and Risk Factors for Chronic Anterior Knee Pain.

Chronic anterior knee pain is a common clinical entity, more so in the active individual. The incidence and risk factors, however remain unexplored. We investigated the correlation of demographic and occupational risk factors as well as the incidence of chronic anterior knee pain in an active military population.

Surgical Repair of Medial Collateral Ligament and Posteromedial Corner Injuries of the Knee: A Systematic Review.

Purpose: To systematically evaluate surgical techniques and objective clinical outcomes of primary repair of the medial collateral ligament (MCL) and posteromedial corner of the knee.

Methods: A systematic review of the PubMed/Medline Database (1966 to August 2014) was performed to identify all clinical studies describing MCL and other medial-based repairs of the knee. Exclusion criteria were applied to reconstruction techniques, animal models, and non-English publications.

Aggressive gastrointestinal stromal tumor with spinal metastases: a case report.

We report a case of a 56-year-old male who presented with several month history of severe low back pain. Physical examination revealed generalized tenderness at his thoracolumbar spine without notable neuromuscular findings. Radiographs revealed a chronic compression fracture of T10 and T11 with anterior height loss.

Management and prevention of acute and chronic lateral ankle instability in athletic patient populations.

Acute and chronic lateral ankle instability are common in high-demand patient populations. If not managed appropriately, patients may experience recurrent instability, chronic pain, osteochondral lesions of the talus, premature osteoarthritis, and other significant long-term disability. Certain populations, including young athletes, military personnel and those involved in frequent running, jumping, and cutting motions, are at increased risk.

Patient-Based and Surgical Risk Factors for 30-Day Postoperative Complications and Mortality After Ankle Fracture Fixation.

Objective: The purpose was to calculate the incidence rates and determine risk factors for 30-day postoperative mortality and morbidity after ankle fracture open reduction and internal fixation (ORIF).

Methods: The NSQIP database was queried to identify patients undergoing ankle fracture ORIF from 2006 to 2011, with extraction patient-based or surgical variables and a 30-day clinical course. Multivariable logistic regression analysis identified significant predictors on outcome measures.

Return to Work and Functional Outcomes Following Primary Total Knee Arthroplasty in U.S. Military Servicemembers.

Unlabelled: This investigation sought to determine occupational outcomes after total knee arthroplasty (TKA) in a high-demand cohort. A total of 159 military servicemembers underwent 181 primary TKAs with mean follow-up of 4.1 (range, 2.

Predictors of length of stay after elective total shoulder arthroplasty in the United States.

Background: Total shoulder arthroplasty (TSA) is an increasingly used treatment of glenohumeral arthritis and proximal humerus fractures. However, patient-specific characteristics affecting length of hospital stay postoperatively have not been elucidated.

Methods: All patients undergoing primary unilateral TSA between 2005 and 2011 were isolated from the National Surgical Quality Improvement Program database.

Orthobiological augmentation of consecutive rotator cuff repair failure and deltoid dehiscence.

We present a case of postsurgical deltoid insufficiency occurring after augmented revision of a failed prior rotator cuff repair. Revision deltoid repair with deltoid imbrication and orthobiological augmentation was dually performed, resulting in successful deltoid and rotator cuff healing and improved clinical outcomes.

Successful nonoperative management of coracoid fracture associated with suture-button fixation of acromioclavicular separation.

A young active duty soldier underwent acromioclavicular reconstruction with hamstring autograft after sustaining a shoulder separation. At 3 months postoperatively, the patient fell and sustained a fracture of the coracoid process. The patient elected for nonoperative management of the coracoid fracture.

Postoperative myocardial infarction and cardiac arrest following primary total knee and hip arthroplasty: rates, risk factors, and time of occurrence.

Background: Cardiac complications are a major cause of postoperative morbidity. The purpose of this study was to determine the rates, risk factors, and time of occurrence for cardiac complications within thirty days after primary unilateral total knee arthroplasty and total hip arthroplasty.

Methods: The American College of Surgeons National Surgical Quality Improvement Program data set from 2006 to 2011 was used to identify all total knee arthroplasties and total hip arthroplasties.

Increasing patient satisfaction: a new model development.

Most patient satisfaction studies put an emphasis on finding key drivers (attribute) to increase overall patient satisfaction. However, it is not clear how much health care managers need to improve certain attributes to attain the target overall patient satisfaction level. The study aims at finding not only what attributes, but also how much these attributes need to be improved to attain the target levels of patient satisfaction.

Chronic exertional compartment syndrome of the leg in the military.

CECS is a common source of lower extremity disability among young athletic cohorts and military personnel. The five cardinal symptoms are pain, tightness, cramps, weakness, and diminished sensation. History and clinical examination remain the hallmarks for identifying CECS, although ICP measurements during exercise stress testing may be used to confirm diagnosis.

Management of chronic lateral ankle instability in military service members.

Chronic lateral ankle instability is a condition frequently encountered by orthopedic surgeons treating highly active patient populations, particularly military service members. Providers treating military service members must have a high index of suspicion for this condition when signs and symptoms of functional or mechanical instability exist. Stress testing and ankle MRI, although not definitive in sensitivity for detecting instability or other concomitant injuries, should be considered during the treatment decision-making process.

Thirty-day morbidity and mortality after elective total shoulder arthroplasty: patient-based and surgical risk factors.

Background: Total shoulder arthroplasty (TSA) is an effective treatment for painful glenohumeral arthritis, but its morbidity has not been thoroughly documented.

Methods: The National Surgical Quality Improvement Program database was queried to identify all patients undergoing primary TSA between 2006 and 2011, with extraction of selected patient-based or surgical variables and 30-day clinical course. Postoperative complications were stratified as major systemic, minor systemic, major local, and minor local, and mortality was recorded.

Morbidity and mortality in the thirty-day period following total hip arthroplasty: risk factors and incidence.

The study sought to ascertain the incidence rates and risk factors for 30-day post-operative complications after primary total hip arthroplasty (THA). Complications were categorized as systemic or local and subcategorized as major or minor. There were 17,640 individuals who received primary THA identified from the 2006-2011 ACS NSQIP.

Enhanced casualty care from a Global Military Orthopaedic Teleconsultation Program.

Background: Since its advent, telemedicine has facilitated access to subspecialty medical care for the treatment of patients in remote and austere settings. The United States military introduced a formal orthopaedic teleconsultation system in 2007, but few reports have explored its scope of practice and efficacy, particularly in a deployed environment during a time of conflict.

Methods: All teleconsultations placed to the orthopaedic service between April 2009 and December 2012 were obtained and retrospectively reviewed.

Adding socioeconomic data to hospital readmissions calculations may produce more useful results.

To better understand the degree to which risk-standardized thirty-day readmission rates may be influenced by social factors, we compared results for hospitals in Missouri under two types of models. The first type of model is currently used by the Centers for Medicare and Medicaid Services for public reporting of condition-specific hospital readmission rates of Medicare patients. The second type of model is an "enriched" version of the first type of model with census tract-level socioeconomic data, such as poverty rate, educational attainment, and housing vacancy rate.