Management of Patients With Gastric Varices.

Management of patients with gastric varices represents a unique challenge for clinicians. The broad range of endoscopic and endovascular techniques currently available is in stark contrast with the limited evidence available to inform the optimal management of these patients. This article describes the classification, pathophysiology, and natural history of gastric varices; summarizes the available evidence regarding medical, endoscopic, and endovascular management of gastric varices; and provides recommendations on how to integrate these options.

Prolonged Prone Position Ventilation Is Associated With Reduced Mortality in Intubated COVID-19 Patients.

Background: Prone position ventilation (PPV) is resource-intensive, yet the optimal strategy for PPV in intubated patients with COVID-19 is unclear.

Research Question: Does a prolonged (24 or more h) PPV strategy improve mortality in intubated COVID-19 patients compared with intermittent (∼16 h with daily supination) PPV?

Study Design And Methods: Multicenter, retrospective cohort study of consecutively admitted intubated COVID-19 patients treated with PPV between March 11 and May 31, 2020. The primary outcome was 30-day all-cause mortality.

Arthroscopic assessment of syndesmotic instability: Are we pulling correctly in the coronal plane?

Background: While the lateral hook test (LHT) has been widely used to arthroscopically evaluate syndesmotic instability in the coronal plane, it is unclear whether the angulation of the applied force has any impact on the degree of instability. We aimed to determine if changing the direction of the force applied while performing the LHT impacts the amount of coronal diastasis observed in subtle syndesmotic injuries.

Methods: In 10 cadaveric specimens, arthroscopic evaluation of the syndesmotic joint was performed by measuring anterior and posterior-third coronal plane diastasis in the intact state, and repeated after sequential transection of the 1) anterior inferior tibiofibular ligament (AITFL), 2) interosseous ligament (IOL), and 3) posterior inferior tibiofibular ligament (PITFL).

Impact of Race and Ethnicity on Perioperative Outcomes During Hysterectomy for Endometriosis.

Study Objective: To assess whether complications incurred during hysterectomy for the treatment of endometriosis differ among racial-ethnic groups.

Design: Retrospective cohort study.

Setting: American College of Surgeons National Surgical Quality Improvement Program database from 2014 to 2019.

Posterior mesh inguinal hernia repairs: a propensity score matched analysis of laparoscopic and robotic versus open approaches.

Purpose: International guidelines suggest the use of lapro-endoscopic technique for primary unilateral inguinal hernia (IHR) because of lower postoperative pain and reduction in chronic pain. It is unclear if the primary benefit is due to the minimally invasive approach, the posterior mesh position or both. Further research evaluating posterior mesh placement using open preperitoneal techniques is recommended.

Which Factors Are Considered by Patients When Considering Total Joint Arthroplasty? A Discrete-choice Experiment.

Background: TKA and THA are major surgical procedures, and they are associated with the potential for serious, even life-threatening complications. Patients must weigh the risks of these complications against the benefits of surgery. However, little is known about the relative importance patients place on the potential complications of surgery compared with any potential benefit the procedures may achieve.

Injuries to Ice Hockey Referees and Linesmen: A Survey of International Ice Hockey Federation Officials.

Background: Ice hockey referees and linesmen are at risk for musculoskeletal injuries because of the lack of protective equipment and contact with players, sticks, pucks, the ice surface and boards.

Purpose: To quantify and analyze injuries reported by officials of the International Ice Hockey Federation (IIHF).

Study Design: Descriptive epidemiology study.

Impact of the COVID-19 pandemic on shoulder arthroplasty: surgical trends and postoperative care pathway analysis.

Background: COVID-19 triggered disruption in the conventional care pathways for many orthopedic procedures. The current study aims to quantify the impact of the COVID-19 pandemic on shoulder arthroplasty hospital surgical volume, trends in surgical case distribution, length of hospitalization, posthospital disposition, and 30-day readmission rates.

Methods: This study queried all Medicare (100% sample) fee-for-service beneficiaries who underwent a shoulder arthroplasty procedure (Diagnosis-Related Group code 483, Current Procedural Terminology code 23472) from January 1, 2019, to December 18, 2020.

Fluoroscopic Evaluation of the Role of Syndesmotic Injury in Lateral Ankle Instability in a Cadaver Model.

Background: There is a high prevalence of concomitant lateral ankle ligament injuries and syndesmotic ligamentous injuries. However, it is unclear whether syndesmotic ligaments directly contribute toward the stability of the lateral ankle. Therefore, the aim of this study was to fluoroscopically evaluate the role of the syndesmotic ligaments in stabilizing the lateral ankle.

Results of a 2-year lifestyle intervention for type 2 diabetes: the Reach Ahead for Lifestyle and Health-Diabetes randomized controlled trial.

Objective: The Reach Ahead for Lifestyle and Health (REAL HEALTH)-Diabetes study assessed the comparative effectiveness of two Look AHEAD (Action for Health in Diabetes)-adapted lifestyle intervention (LI) arms targeting weight loss in type 2 diabetes compared with medical nutrition therapy (MNT) referral. At 1 year, LI had greater weight loss than MNT. This study reports outcomes at 24 (end of LI) and 36 months.

Predictors of low and high opioid tablet consumption after inguinal hernia repair: an ACHQC opioid reduction task force analysis.

Purpose: Prescribing and consumption of opioids remain highly variable. Using a national hernia registry, we aimed to identify patient and surgery specific factors associated with low and high opioid tablet consumption after inguinal hernia repair.

Methods: This was a retrospective cross-sectional study evaluating patients undergoing elective inguinal hernia repair with 30-day follow-up and patient-reported opioid consumption from March 2019 to March 2021 using the Abdominal Core Health Quality Collaborative.

Implementation of a Coaching Program by a National Surgical Association.

Objective: Using the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework for implementation science, we describe the implementation and impact of a virtual coaching program designed and conducted through a national surgical organization.

Design: The Association of Women Surgeons recruited and trained surgical faculty as coaches with no prior training in positive psychology to coach surgical residents. Coaching pairs completed three coaching sessions center on strength recognition, personal and professional fulfillment, and work life integration.

Dislocation After Debridement, Antibiotics, and Implant Retention for Periprosthetic Joint Infections of the Hip.

Background: Debridement, antibiotics, and implant retention (DAIR) is a common treatment option for hip periprosthetic joint infection (PJI). However, noninfectious outcomes of DAIR such as instability are not well reported. The purpose of this study was to evaluate risk factors for hip dislocation post-DAIR for PJI of both primary and revision total hip arthroplasty (THA).

Intraoperative Factors Associated with More Postoperative Opioid Use after Laparoscopic Hysterectomy.

Background And Objectives: To identify intraoperative factors during laparoscopic hysterectomy associated with postoperative opioid use and increased pain scores during the acute postoperative period.

Methods: This is a prospective survey-based cohort study at two teaching hospitals in the Boston metropolitan area. A total of 125 patients undergoing laparoscopic hysterectomy were enrolled.

Adenomyosis and fertility: does adenomyosis impact fertility and does treatment improve outcomes.

Purpose Of Review: Adenomyosis has recently been associated with infertility. Relief of bleeding and pain has been demonstrated with medical and surgical therapy. Less is known about reproductive outcomes after treatment.

Level-loading a health system by transferring emergency department patients to a community hospital: Prospective cohort study.

Background: Emergency department boarding and crowding lead to worse patient outcomes and patient satisfaction.

Objective: We describe the implementation of a program to transfer patients requiring medical admission from an academic emergency department to a community hospital's medical floor and analyze its effects on patient outcomes.

Methods: A prospective cohort study was performed.

Portable dynamic ultrasonography is a useful tool for the evaluation of suspected syndesmotic instability: a cadaveric study.

Purpose: Portable ultrasonography (P-US) is increasingly used to diagnose syndesmotic instability. The aim of this study was to evaluate syndesmotic instability by measuring the distal tibiofibular clear space (TFCS) in a cadaveric model using P-US with progressive stages of syndesmotic ligamentous transection under external rotation stress.

Methods: Ten fresh lower leg cadaveric specimens amputated above the proximal tibiofibular joint were used.

The role of parental health and distress in assessing children's health status.

Purpose: The purpose of the study was to examine the contributions of parents' health and distress to parent's and children's assessments of children's health.

Methods: We used baseline data from a longitudinal study of 364 children (ages 4-12) about to undergo surgery and their parents in a Southern California pediatric hospital. We used the 20-item child self-reported CHRIS 2.

Partial and complete explantation of aortic endografts in the modern era.

Objective: Despite the progressive advancement of devices for endovascular aortic repair (EVAR), endografts continue to fail, requiring explant. We present a single-institutional experience of EVAR explants, characterizing modern failure modes, presentation, and outcomes for partial and complete EVAR explantation.

Methods: A retrospective analysis was performed of all EVARs explanted at an urban quaternary center from 2001 to 2020, with one infected endograft excluded.

The Effects of Chronic Ankle Instability on the Biomechanics of the Uninjured, Contralateral Ankle During Gait.

Objective: To determine whether unilateral chronic ankle instability (CAI) affects the kinematics of the uninjured contralateral ankle.

Methods: In this case-control study, 15 adult patients with unilateral CAI and 15 healthy controls were studied. Both the unstable and uninjured ankles in patients with unilateral CAI (CAI group, n = 15) were compared with that of healthy individuals (control group, n = 15).

Trabecular metal augments in severe malignancy-associated acetabular bone loss.

Introduction: Acetabular reconstruction is a challenging problem in orthopaedic oncology, especially in extended defects (Paprosky Type 3A and Type 3B). In revision total hip arthroplasty (THA), 1 option is trabecular metal (TM) augments with a porous metal acetabular component. This study evaluated the use of TM augments in periacetabular malignant bone disease.