Risk factors for rehospitalization within 90 days in patients with total joint replacement: A meta-analysis.

BACKGROUND: The risk factors influencing the readmission within 90 days following total joint replacement (TJR) are complex and heterogeneous, and few systematic reviews to date have focused on this issue. METHODS: Web of Science, Embase, PubMed, and Chinese National Knowledge Infrastructure databases were searched from the inception dates to December 2022. Relevant, published studies were identified using the following keywords: risk factors, rehospitalization, total hip replacement, total knee replacement, total shoulder replacement, and total joint replacement. All relevant data were collected from the studies that meet the inclusion criteria. The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS: Of 68,336 patients who underwent TJR, 1,269,415 (5.4%) were readmitted within 90 days. High American Society of Anesthesiologists (ASA) class (OR, 1.502; 95%CI:1.405-1.605; P < .001), heart failure (OR,1.494; 95%CI: 1.235-1.754; P < .001), diabetes (OR, 1.246; 95%CI:1.128-1.377; P < .001), liver disease (OR, 1.339; 95%CI:1.237-1.450; P < .001), drinking (OR, 1.114; 95%CI:1.041-1.192; P = .002), depression (OR, 1.294; 95%CI:1.223-1.396; P < .001), urinary tract infection (OR, 5.879; 95%CI: 5.119-6.753; P < .001), and deep vein thrombosis (OR, 10.007; 95%CI: 8.787-11.396; P < .001) showed statistically positive correlation with increased 90-day readmissions after TJR, but high blood pressure, smoking, and pneumonia had no significant association with readmission risk. CONCLUSION: The findings of this review and meta-analysis will aid clinicians as they seek to understand the risk factors for 90-day readmission following TJR. Clinicians should consider the identified key risk factors associated with unplanned readmissions and develop strategies to risk-stratify patients and provide dedicated interventions to reduce the rates of readmission and enhance the recovery process.

Detecting novel Indel variants within the GHR gene and their associations with growth traits in Luxi Blackhead sheep.

The growth hormone is important in the regulation of metabolism and energy homeostasis and acts through a growth hormone receptor (GHR). In this work, genetic variations within the ovine GHR gene were identified and tested for associations with body morphometric traits in Chinese Luxi Blackhead (LXBH) sheep. Novel deletion loci in the LXBH GHR gene included P2-del-23 bp and P8-del-23 bp indel variants. The polymorphic information content (PIC) was 0.329 in P2-del-23 bp and 0.257 in P8-del-23 bp. Moreover, both indel polymorphisms were not at Hardy-Weinberg equilibrium (p < 0.05) in the LXBH population. Statistical analyses revealed that the P2-del-23 bp and P8-del-23 bp indels were significantly associated (p < 0.05) with several growth traits in rams and ewes, including body weight, body height, chest depth, chest width, chest circumference, cannon circumference, paunch girth and hip width. Among the tested sheep, the body traits of those with genotype DD were superior to those with II and ID genotypes, suggesting that the 'D' allele was responsible for the positive effects on growth traits. Thus, these results indicate that the P2-del-23 bp and P8-del-23 bp indel sites and the DD genotype can be useful in marker-assisted selection in sheep.

[Spinal canal decompression with microendoscopic disectomy and pillar vertebral space insertion for thoracolumbar neglected fracture].

OBJECTIVE: To investigate the effectiveness of spinal canal decompression with microendoscopic disectomy (MED) and pillar vertebral space insertion through pedicle of vertebral arch for thoracolumbar neglected fracture. METHODS: Between February 2006 and November 2009, 30 patients with thoracolumbar neglected fracture were treated by spinal canal decompression with MED and pillar vertebral space insertion through pedicle of vertebral arch. There were 22 males and 8 females with an average age of 36.2 years (range, 17-58 years). The disease duration was 6 weeks to 14 months with an average of 5.3 months. All patients had single vertebral compression fracture, including T9 in 1 case, T11 in 2 cases, T12 in 5 cases, L1 in 11 cases, L2 in 5 cases, L3 in 5 cases, and L4 in 1 case. The preoperative Cobb angle was (27.5 +/- 7.5) degrees. The preoperative height of vertebrae was (26.67 +/- 5.34) mm. The visual analogue score (VAS) was 5.8 +/- 1.4. According to Wolter classification for spinal canal stenosis, there were 17 cases of grade 1, 10 cases of grade 2, and 3 cases of grade 3. According to Frankel grade, 3 cases were in grade A, 8 cases in grade B, 13 cases in grade C, and 6 cases in grade D. RESULTS: The average operation time was 70 minutes (range, 40-120 minutes) and the average blood loss was 180 mL (range, 100-400 mL). The hematoma occurred in 1 case, and other incisions healed by first intension. No deep vein thrombosis of the lower extremity occurred. All patients were followed up 26 months on average (range, 24-46 months). The Cobb angle and vertebral height at 3 days and last follow-up were significantly improved when compared with ones before operation (P < 0.01). At last followup, the spinal canal stenosis was grade 0 in 27 cases and grade 1 in 3 cases according to Wolter classification. At 24 months after operation, the spinal function was obviously improved; 1 case was in grade A, 1 case in grade B, 3 cases in grade C, 9 cases in grade D, and 16 cases in grade E according to Frankle grade, showing significant differences when compared with preoperative ones (P < 0.05). The VAS score at 1 month after operation was significantly higher than that before operation (P < 0.01), then the score showed downtrend along with time, and it was significantly lower at 24 months after operation than before operation (P < 0.01). CONCLUSION: Spinal canal decompression with MED and pillar vertebral space insertion for thoracolumbar neglected fracture has short surgical time, less blood loss, and satisfactory reduction, but higher technical requirement is necessary for MED.