ABSTRACT
Background@#Racial and ethnic disparities in orthopedic surgery may be associated with worse perioperative complications. For patients with hip fractures, studies have shown that early surgery, typically within 24 to 48 hours of admission, may decrease postoperative morbidity and mortality. Our objective was to determine whether race is associated with longer time to surgery from hospital presentation and increased postoperative complications. @*Methods@#We queried the National Surgical Quality Improvement Program database from 2011 to 2017 for patients (> 65 years) with hip fractures who underwent surgical fixation. Patients were identified using Current Procedural Terminology codes (27235, 27236, 27244, and 27245). Delayed surgery was defined as time to surgery from hospital admission that was greater than 48 hours. Time to surgery was compared between races using analysis of variance. A multivariate logistic regression analysis adjusting for comorbidities, age, sex, and surgery was performed to determine the likelihood of delayed surgery and rate of postoperative complications. @*Results@#A total of 58,456 patients who underwent surgery for a hip fracture were included in this study. Seventy-two percent were female patients and the median age was 87 years. The median time to surgery across all patients was 24 hours. African Americans had the longest time to surgery (30.4 ± 27.6 hours) compared to Asians (26.5 ± 24.6 hours), whites (25.8 ± 23.4 hours), and other races (22.7 ± 22.0 hours) (p < 0.001). After adjusting for comorbidities, age, sex, and surgery, there was a 43% increase in the odds of delayed surgery among American Africans compared to whites (odds ratio, 1.43; 95% confidence interval, 1.29–1.58; p < 0.001). Despite higher odds of reintubation, pulmonary embolism, renal insufficiency or failure, and cardiac arrest in African Americans, mortality was significantly lower compared to white patients (4.41% vs. 6.02%, p < 0.001). Asian Americans had the lowest mortality rate (3.84%). @*Conclusions@#A significant disparity in time to surgery and perioperative complications was seen amongst different races with only African Americans having a longer time to surgery than whites. Further study is needed to determine the etiology of this disparity and highlights the need for targeted strategies to help at-risk patient populations.
ABSTRACT
Shoulder arthroscopy is currently one of the mainstay procedures for the treatment and diagnosis of shoulder disorders. Shoulder arthroscopy is typically performed in either the beach chair position or the lateral decubitus position. In this article, we discuss the advantages and disadvantages of each position. Of note, there currently is no consensus regarding a preferred positioning. Both the lateral decubitus and the beach chair position require the same preparations prior to the procedure. The advantages of the beach chair position are numerous, the most significant of which is the lower risk of neurovascular trauma and an easier conversion to the open approach. Conversely, the main disadvantage of this position is the risk of cerebral hypoperfusion. In regard to the lateral decubitus position, the main advantages are the lower recurrence rates and a better visualization of labral tears. The disadvantages entail an increase risk of neurovascular injury among others. This article will also briefly examine a third position, the supine position, which was recently described to combine the advantages of both the lateral decubitus and beach chair with minimal disadvantages