Predictors of 30-day mortality, unplanned related readmission and reoperation among isolated closed femoral shaft fractures.

Background: Isolated, closed, femoral shaft fractures are dangerous injuries that commonly occur in the setting of high energy trauma or among older patients with significant comorbidities. Despite their prevalence, relatively little data exists connecting patient independent risk factors to the time to 30-day mortality, unplanned reoperations and unplanned readmissions in these fractures. Methods: Using National Surgical Quality Improvement Program (NSQIP) database, isolated close femoral shaft fractures were identified using ICD-10 codes. Patient demographics, perioperative course and adverse events were identified. Categorical and binary variables were analyzed among procedure cohorts using Chi2 analysis. Univariate and multivariate analysis were conducted to identify independent risk factors associated with primary outcomes. Results: Between 2010 and 2019, 1346 closed isolated femoral shaft fracture patients with a mean age of 66.7 were identified, of whom 30.6% and 69.4% were male and female, respectively. Surgical procedures included: 915 (68.0%) intramedullary nail (IMN); 428 (31.8%) open reduction internal fixation (ORIF); and 3 (0.2%) external fixator (Ex-fix). Patients who underwent ORIF reported 3.19 (OR: 3.19; CI: 1.45-7.03; p = 0.004) and 2.12 (OR: 2.12; CI: 1.10-4.09; p = 0.024) increased odds of mortality and unplanned related readmission compared to patients who received IMN. Transfusion, DVT, and PE rates were 34.2%, 1.4%, and 1.1%, respectively. Furthermore, 50% of mortality cases occurred within 6 days of surgery. Patients requiring reintubation reported 61.8 (OR: 61.8; CI: 15.7-242.40; p < 0.001) increased odds of mortality compared to patients not requiring reintubation. Conclusion: Patients with femoral shaft fractures who require reintubation have increased odds of mortality than those successfully extubated. In addition to precautions prior to extubation, patients with femoral shaft fractures should also be carefully monitored for the development of DVT or PE, and they should be definitively fixed with IMN whenever possible.

E-scooter use continues to rev up fracture diagnoses and hospital admissions compared to other modes of transportation.

Introduction: The COVID-19 pandemic was associated with an increase in popularity of e-scooter usage and a rise in e-scooter related injuries. Recent studies have elucidated trends within e-scooter injuries but there are few epidemiological studies that evaluate injury rates amongst multiple modes of transportation. This study seeks to investigate trends of e-scooter orthopedic fracture injuries compared to other traditional methods of transportation using a national database. Methods: The National Electronic Injury Surveillance System (NEISS) database was queried between 2014 and 2020 for patients who were injured after usage of e-scooters, bicycles, or all-terrain vehicles. Primary analysis included patients with a diagnosis of fracture and utilized univariate/multivariate models to evaluate risk of hospital admission. Secondary analysis included all isolated patients to evaluate the odds of fracture development amongst modes of transportation. Results: A total of 70,719 patients with injuries associated with e-scooter, bicycle, or all-terrain vehicle use were isolated. 15997 (22.6%) of these patients had a fracture diagnosis. Both e-scooters and all-terrain vehicles reported increased odds of fracture-related injury and direct hospitalization when compared to bicycles. E-scooter users reported a greater odds of both associated fracture (OR 1.25; 95%CI 1.03-1.51; p = 0.024) and hospital admission (OR: 2.01; 95%CI: 1.26-3.21; p = 0.003) in 2020 compared to 2014-2015. Discussion: E-scooter related orthopedic injuries and hospital admissions had the largest incidence rate increase compared to bicycle and all-terrain vehicles between 2014 and 2020. E-scooter fractures were most commonly located in the lower leg in 2014-2017, the wrist in 2018-2019, and the upper trunk in 2020. In comparison, bicycle and all-terrain vehicle fractures was most commonly shoulder and upper trunk within the study period. Further research will help to promote further understanding of the e-scooter health care burden and in prevention of these injuries. Level of evidence: 3.

The Impact of Isolated Preoperative Cannabis Use on Outcomes Following Cervical Spinal Fusion: A Propensity Score-Matched Analysis.

Background: Cannabis is the most commonly used recreational drug in the USA. Studies evaluating cannabis use and its impact on outcomes following cervical spinal fusion (CF) are limited. This study sought to assess the impact of isolated (exclusive) cannabis use on postoperative outcomes following CF by analyzing outcomes like complications, readmissions, and revisions. Methods: The New York Statewide Planning and Research Cooperative System (SPARCS) was queried for patients who underwent CF between January 2009 and September 2013. Inclusion criteria were age ≥18 years and either a minimum 90-day (for complications and readmissions) or 2-year (for revisions) follow-up surveillance. Patients with systemic disease, osteomyelitis, cancer, trauma, and concomitant substance or polysubstance abuse/dependence were excluded. Patients with a preoperative International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) diagnosis of isolated cannabis abuse (Cannabis) or dependence were identified. The primary outcome measures were 90-day complications, 90-day readmissions, and two-year revisions following CF. Cannabis patients were 1:1 propensity score-matched by age, gender, race, Deyo score, surgical approach, and tobacco use to non-cannabis users and compared for outcomes. Multivariate binary stepwise logistic regression models identified independent predictors of outcomes. Results: 432 patients (n=216 each) with comparable age, sex, Deyo scores, tobacco use, and distribution of anterior or posterior surgical approaches were identified (all p>0.05). Cannabis patients were predominantly Black (27.8% vs. 12.0%), primarily utilized Medicaid (29.6% vs. 12.5%), and had longer LOS (3.0 vs. 1.9 days), all p≤0.001. Both cohorts experienced comparable rates of 90-day medical and surgical, as well as overall complications (5.6% vs. 3.7%) and two-year revisions (4.2% vs. 2.8%, p=0.430), but isolated cannabis patients had higher 90-day readmission rates (11.6% vs. 6.0%, p=0.042). Isolated cannabis use independently predicted 90-day readmission (Odds Ratio=2.0), but did not predict any 90-day complications or two year revisions (all p>0.05). Conclusion: Isolated baseline cannabis dependence/abuse was associated with increased risk of 90-day readmission following CF. Further investigation of the physiologic impact of cannabis on musculoskeletal patients may elucidate significant contributory factors. Level of Evidence: III.

Differences in Infection Rates by Surgical Approach in Total Hip Arthroplasty and Patient Sex: A Systematic Review.

Background: There exists conflicting data that patient sex may influence complication and revision rates when undergoing total hip arthroplasty (THA), specifically when comparing different surgical approaches. Differences in body fat or muscular distribution are proposed mechanisms, but these are poorly understood and not well described in current literature. Methods: A systematic review of the literature was conducted from PubMed, Embase, and Web of Science from inception of the database through September 15, 2020. Studies were included if they included patients undergoing primary elective unilateral THA, delineated infections by surgical approach, and delineated infections by patient sex. Basic science, cadaveric, and animal studies were excluded as were case reports. Two authors screened abstracts and then extracted data from the full text article. Results: Three studies, including 1,694 patients undergoing 1,811 THA were included. 80 infections were included. No study reported a statistically significant difference in infection risk by patient sex or surgical approach, though there was substantial heterogeneity in study design, approach, and analysis. Conclusion: Limited data suggests no relationship between sexes across surgical approaches for infection rates. However, poor reporting and small sample sizes preclude definitive conclusions from being drawn. Future studies should emphasize reporting differences in outcomes by patient sex to better elucidate differences, if any, in adverse outcomes between sexes following THA across surgical approaches. Level of Evidence: IV.