Dependent status is a risk factor for complications after thyroidectomy.

BACKGROUND: Functional dependency has been associated with increased risk of adverse events following many surgical procedures. We hypothesized that dependent patients would have an increased risk of complications following thyroidectomy. METHODS: We performed a retrospective review of total thyroidectomies performed from 1/2012-12/2019 as identified by CPT codes using the National Surgical Quality Improvement Project (NSQIP) database. Functional dependent status was identified from within the NSQIP database with partially or totally dependent combined into the dependent group. RESULTS: A total of 64,978 patients were included, with 0.53% identified as functionally dependent (FD). Functional dependency was associated with an increased risk of wound disruption, pneumonia, UTI, stroke, cardiac arrest, PE/DVT, and sepsis/septic shock. Dependent patients had higher rates of unplanned intubation, ventilator use, and significant bleeding. On multivariate analysis, FD patients were more likely to suffer from major complications and have an increased length of stay. CONCLUSIONS: Dependent status was associated with an increased risk of complications following thyroidectomy. Focused preoperative and disposition planning for these patients can help to minimize adverse outcomes and optimize resource utilization.

Combined Acetabulum Fracture and Hip Dislocation in an 18-Year-Old Female at 35-Week Gestation: A Case Report and Review of the Literature.

Caring for an injured, pregnant patient can be a management challenge. We report the case of an 18-year-old female who sustained a left acetabulum fracture with a concurrent hip dislocation at 35 weeks' gestation following a motor vehicle accident. Through an interdisciplinary, team-based approach, the patient was guided through obstetric delivery and orthopedic surgical fracture fixation without complication. By being familiar with the unique challenges in management posed by pregnant patients, orthopedic surgeons can be better equipped to minimize morbidity and mortality in this patient population while maximizing clinical outcomes.

Perioperative Management of Orthopaedic Patients with Hematologic Disorders: A Critical Analysis Review.

Perioperative management of orthopaedic patients with a hematologic disorder is a complex endeavor that requires a multidisciplinary team-based approach. A team composed of an experienced orthopaedic surgeon, an anesthesiologist, and a hematologist is necessary to achieve optimal outcomes. Patients with hemophilia and other complex hematologic disorders should be managed at, or in consultation with a hematologist at, a comprehensive hemophilia center. Bleeding disorders and inherited thrombophilia present unique challenges for the perioperative management of orthopaedic surgery. Comprehensive preoperative planning and familiarity with treatment guidelines can help to minimize these risks. Knowledge of the disease processes outlined in this article will provide orthopaedic surgeons with the requisite background knowledge that is needed to initiate safe and effective treatment strategies involving this high-risk patient population.