Total Joint Arthroplasty Outcomes in Eligible Patients Versus Patients Who Failed to Meet at Least 1 Eligibility Criterion: A Single-Center Retrospective Analysis.

BACKGROUND: This study looks to investigate how not meeting eligibility criteria affects postoperative outcomes following total joint arthroplasty surgery. METHODS: A retrospective review was conducted of total joint arthroplasty patients at a single academic institution. Demographics, laboratory values, and complications were recorded. Continuous and categorical variables were compared using the Student's T-test and the Chi-Square test, respectively. Multivariable analysis was used to control for confounding variables. RESULTS: Our study included 915 total hip and 1,579 total knee arthroplasty patients. For total hip and total knee arthroplasty, there were no significant differences in complications (P = .11 and .87), readmissions (P = .83 and .2), or revision surgeries (P = .3 and 1) when comparing those who met all criteria to those who did not. Total hip arthroplasty patients who did not meet two criteria had 16.1 higher odds (P = .02) of suffering a complication. There were no differences in complications (P = .34 and .41), readmissions (P = 1 and .55), or revision surgeries (P = 1 and .36) between ineligible patients treated by total joint arthroplasty surgeons and those who were not. Multivariable analysis demonstrated no eligibility factors were associated with outcomes for both total hip and knee arthroplasty. CONCLUSIONS: There was no significant difference in outcomes between those who met all eligibility criteria and those who did not. Not meeting two criteria conferred significantly higher odds of suffering a complication for total hip arthroplasty patients. Total joint arthroplasty surgeons had similar outcomes to non-total joint surgeons, although their patient population was more complex. LEVEL OF EVIDENCE: III.

Examining pediatric resuscitation education using simulation and scripted debriefing: a multicenter randomized trial.

IMPORTANCE: Resuscitation training programs use simulation and debriefing as an educational modality with limited standardization of debriefing format and content. Our study attempted to address this issue by using a debriefing script to standardize debriefings. OBJECTIVE: To determine whether use of a scripted debriefing by novice instructors and/or simulator physical realism affects knowledge and performance in simulated cardiopulmonary arrests. DESIGN Prospective, randomized, factorial study design. SETTING: The study was conducted from 2008 to 2011 at 14 Examining Pediatric Resuscitation Education Using Simulation and Scripted Debriefing (EXPRESS) network simulation programs. Interprofessional health care teams participated in 2 simulated cardiopulmonary arrests, before and after debriefing. PARTICIPANTS: We randomized 97 participants (23 teams) to nonscripted low-realism; 93 participants (22 teams) to scripted low-realism; 103 participants (23 teams) to nonscripted high-realism; and 94 participants (22 teams) to scripted high-realism groups. INTERVENTION Participants were randomized to 1 of 4 arms: permutations of scripted vs nonscripted debriefing and high-realism vs low-realism simulators. MAIN OUTCOMES AND MEASURES: Percentage difference (0%-100%) in multiple choice question (MCQ) test (individual scores), Behavioral Assessment Tool (BAT) (team leader performance), and the Clinical Performance Tool (CPT) (team performance) scores postintervention vs preintervention comparison (PPC). RESULTS: There was no significant difference at baseline in nonscripted vs scripted groups for MCQ (P = .87), BAT (P = .99), and CPT (P = .95) scores. Scripted debriefing showed greater improvement in knowledge (mean [95% CI] MCQ-PPC, 5.3% [4.1%-6.5%] vs 3.6% [2.3%-4.7%]; P = .04) and team leader behavioral performance (median [interquartile range (IQR)] BAT-PPC, 16% [7.4%-28.5%] vs 8% [0.2%-31.6%]; P = .03). Their improvement in clinical performance during simulated cardiopulmonary arrests was not significantly different (median [IQR] CPT-PPC, 7.9% [4.8%-15.1%] vs 6.7% [2.8%-12.7%], P = .18). Level of physical realism of the simulator had no independent effect on these outcomes. CONCLUSIONS AND RELEVANCE: The use of a standardized script by novice instructors to facilitate team debriefings improves acquisition of knowledge and team leader behavioral performance during subsequent simulated cardiopulmonary arrests. Implementation of debriefing scripts in resuscitation courses may help to improve learning outcomes and standardize delivery of debriefing, particularly for novice instructors.

The 2012 Frank Stinchfield Award: Decreasing patient activity with aging: implications for crosslinked polyethylene wear.

BACKGROUND: Patient activity influences polyethylene wear. However, it is unclear how individual activity changes with patient aging after THA. QUESTIONS/PURPOSES: We quantified changes in individual gait cycles and gait speed, assessed age-related differences in these parameters, and determined their relationship to polyethylene wear. METHODS: A microprocessor was worn on the ankle to quantify the activity of 14 healthy patients with a well-functioning THA at two time periods: early (within 3.5 years of implantation) and late (10-13 postoperative years). Wear was measured on serial radiographs using edge detection-based software. RESULTS: Mean activity decreased by 16% from the early to the late period: 2.04 million gait cycles/year to 1.71 million gait cycles/year. Mean gait speed decreased by 9%: 15.4 cycles/minute to 14.0 cycles/minute. The activity of the 10 patients who were younger than 65 years at surgery decreased by 14% (2.34 million gait cycles/year to 2.02 million gait cycles/year), while the four patients 65 years or older at surgery decreased by 28% (1.29 million gait cycles/year to 0.94 million gait cycles/year). Gait speed was 26% slower for patients 65 years or older than for patients younger than 65 years. The mean linear penetration rate decreased by 42% from the first 5 years (early wear rate) to the next 8 years (late wear rate, 5-13 years): 0.043 mm/year to 0.025 mm/year. CONCLUSIONS: The greatest patient activity and wear occurred during the first 5 years. Walking speed and gait cycles both decreased with aging, resulting in deceasing wear over time.

Residual thoracic hypokyphosis after posterior spinal fusion and instrumentation in adolescent idiopathic scoliosis: risk factors and clinical ramifications.

STUDY DESIGN: A retrospective review of clinical and radiographic data from a single-center, prospectively collected scoliosis database. OBJECTIVE: To assess risk factors for persistent thoracic hypokyphosis after posterior spinal fusion and instrumentation (PSFI) for adolescent idiopathic scoliosis (AIS) and to compare clinical outcomes between patients with residual thoracic hypokyphosis and those with normal thoracic kyphosis after PSFI for AIS. SUMMARY OF BACKGROUND DATA: AIS is characterized by thoracic hypokyphosis, which should be corrected at the time of surgical treatment. Risk factors for residual thoracic hypokyphosis and the clinical ramifications have not been studied. METHODS: Radiographic and clinical assessments by using the Scoliosis Research Society-30 (SRS-30) and Spinal Appearance Questionnaire (SAQ) were done preoperatively and at 2 years. Patients were divided into 2 groups on the basis of a threshold of 20° of thoracic kyphosis measured between T5 and T12 at 2-year follow-up. RESULTS: Risk factors for being hypokyphotic at 2 years were male sex (21.69% vs. 12.21%, P = 0.084), preoperative kyphosis (11.4° vs. 22.8°, P < 0.0001), and smaller preoperative main thoracic coronal curves (58.4° vs. 62.0°, P = 0.004). A total of 71.5% of patients instrumented with 6.35-mm rods had normal thoracic kyphosis at 2 years compared with 47.0% instrumented with 5.5-mm rods (P = 0.0043). All-pedicle screw constructs remained hypokyphotic compared with hook-based constructs (P = 0.035). Logistic regression analysis demonstrated 2 parameters associated with persistent thoracic hypokyphosis at 2 years: preoperative hypokyphosis and larger rod diameter. Both groups had similar clinical results on the SRS-30 at 2-year follow-up (P > 0.05). There was a small but statistically significant correlation between sagittal Cobb angle and clinical deformity at 2 years based on the sagittal components of the SAQ. CONCLUSION: There are 2 risk factors that lead to thoracic hypokyphosis in AIS: preoperative hypokyphosis and use of a 5.5-mm-diameter rod. A larger-diameter rod should be considered when planning surgery for thoracic AIS, especially when there is preoperative hypokyphosis. Despite thoracic kyphosis measuring less than 20°, these patients did not have decreased clinical outcomes as measured by the SRS-30 or SAQ.

Spinal appearance questionnaire: factor analysis, scoring, reliability, and validity testing.

STUDY DESIGN: Cross sectional. OBJECTIVE: This study presents the factor analysis of the Spinal Appearance Questionnaire (SAQ) and its psychometric properties. SUMMARY OF BACKGROUND DATA: Although the SAQ has been administered to a large sample of patients with adolescent idiopathic scoliosis (AIS) treated surgically, its psychometric properties have not been fully evaluated. This study presents the factor analysis and scoring of the SAQ and evaluates its psychometric properties. METHODS: The SAQ and the Scoliosis Research Society-22 (SRS-22) were administered to AIS patients who were being observed, braced or scheduled for surgery. Standard demographic data and radiographic measures including Lenke type and curve magnitude were also collected. RESULTS: Of the 1802 patients, 83% were female; with a mean age of 14.8 years and mean initial Cobb angle of 55.8° (range, 0°-123°). From the 32 items of the SAQ, 15 loaded on two factors with consistent and significant correlations across all Lenke types. There is an Appearance (items 1-10) and an Expectations factor (items 12-15). Responses are summed giving a range of 5 to 50 for the Appearance domain and 5 to 20 for the Expectations domain. The Cronbach's α was 0.88 for both domains and Total score with a test-retest reliability of 0.81 for Appearance and 0.91 for Expectations. Correlations with major curve magnitude were higher for the SAQ Appearance and SAQ Total scores compared to correlations between the SRS Appearance and SRS Total scores. The SAQ and SRS-22 Scores were statistically significantly different in patients who were scheduled for surgery compared to those who were observed or braced. CONCLUSION: The SAQ is a valid measure of self-image in patients with AIS with greater correlation to curve magnitude than SRS Appearance and Total score. It also discriminates between patients who require surgery from those who do not.