The purpose of this study was to compare perioperative outcomes between dialysis-dependent and non-dialysis patients undergoing multilevel lumbar fusion. The National Inpatient Sample (2016–2022) was queried for adults undergoing elective multilevel lumbar fusion. Dialysis dependence was identified using ICD-10-CM codes. Demographic, clinical, and hospital characteristics were compared between groups using survey-weighted analyses. Multivariable logistic regression examined the independent association between dialysis status and complications, non-routine discharge, and inpatient mortality. Significance was set at the P < 0.05 level. Among 459,360 weighted admissions, 840 (0.18
BACKGROUND:This study examines 90-day outcomes and one-year outcomes following surgical fixation of upper extremity fractures in homeless patients. METHODS:A retrospective analysis was conducted using a nationwide database to identify patients who underwent open reduction and internal fixation of upper extremity fractures including (shoulder and upper arm, elbow and forearm, wrist and hand) and had documented homelessness status. Patients were 1:1 propensity score-matched to controls based on demographic factors, comorbidities (including chronic kidney disease, hypertension, heart failure, diabetes mellitus, liver diseases, substance abuse and opioid dependence) and BMI yielding 2,584 patients per group. Primary outcomes included fracture related outcomes while secondary outcomes were healthcare utilization, medical and substance related outcomes. Relative risks (RR), 95% confidence intervals (CI), and p-values were calculated. RESULTS:At 90 days, homeless patients had significantly higher risks of emergency department visits (RR: 5.18, p < 0.001), sepsis (p = 0.002), opioid dependence (RR: 2.88, p = 0.002), substance abuse (RR: 5.87, p < 0.001), renal failure (RR: 3.34, p < 0.001), pneumonia (RR: 2.90, p < 0.001), transfusion (RR: 2.61, p = 0.003), readmission (RR: 3.22, p < 0.001), wound complications (RR: 1.97, p < 0.001), and postoperative infection (RR: 2.70, p < 0.001). At 1 year, homeless patients had elevated risks of opioid dependence (RR: 4.69, p < 0.001), substance abuse (RR: 5.72, p < 0.001), opioid use (RR: 1.58, p = 0.011), revision surgery (RR: 1.78, p = 0.017), and malunion (RR: 1.92, p = 0.013). CONCLUSION:Homeless patients undergoing upper extremity fractures ORIF face significantly higher risks of 90 day and 1 year adverse outcomes compared to housed patients. These findings highlight the critical need for tailored interventions to improve care continuity, minimize risks and improve outcomes in homeless individuals. LEVEL OF EVIDENCE:Level III, Retrospective Cohort.
Adhesive capsulitis, commonly referred to as frozen shoulder, is a frequent cause of shoulder pain and stiffness in middle-aged adults and is associated with substantial functional limitation. Although traditionally considered a self-limited condition, growing evidence suggests that many patients experience prolonged symptoms and incomplete recovery. Diagnosis is primarily clinical, based on characteristic history and examination findings demonstrating global restriction of passive glenohumeral motion, with imaging reserved for exclusion of alternative pathology. Management is predominantly nonoperative and should be individualized according to disease stage, symptom severity, and patient comorbidities. Corticosteroid injection and physical therapy provide meaningful benefit in appropriately selected patients, while surgical intervention is reserved for refractory cases. This review summarizes the current understanding of the epidemiology, clinical presentation, diagnostic approach, and evidence-based management of adhesive capsulitis, emphasizing practical considerations to guide patient-centered care.
BACKGROUND:Rotator cuff repair (RCR) is increasingly performed due to advancements in surgical techniques and an aging population. While generally successful, complications like re-tear, stiffness, infection, and thromboembolic events remain concerns. The rising use of testosterone replacement therapy (TRT) in middle-aged and older men raises questions about its impact on surgical outcomes, as its effect on RCR complications remains unclear. METHODS:A retrospective cohort study was conducted using the PearlDiver Database. Patients who underwent arthroscopic RCR between January 2010 and April 2023 were identified using Current Procedural Terminology code 29827. Those with at least two years of continuous follow-up were included, while patients under 21 or with unknown procedural laterality were excluded. Patients were categorized into 2 cohorts: those who received TRT within three months preoperatively and a control group who did not. Propensity score matching (1:1, caliper = 0.001) was performed to control for age, gender, Charlson Comorbidity Index, obesity, tobacco use, and hypogonadism. The primary outcomes included 2-year postoperative complications and reoperations. Secondary outcomes included 90-day major medical complications such as surgical site infection, pneumonia, pulmonary embolism, deep vein thrombosis, urinary tract infection, wound dehiscence, sepsis, acute kidney injury, and readmissions. Statistical analyses were performed using chi-square tests, and odds ratios with 95% confidence intervals were calculated. RESULTS:A total of 8,241 TRT users and 673,982 control patients were identified before matching. After propensity score matching, 5,109 patients remained in each cohort with no significant baseline differences. No significant differences were observed in 90-day postoperative complications, including surgical site infection (0.5% vs. 0.4%, P = .64), pneumonia (0.6% vs. 0.5%, P = .79), sepsis (0.4% vs. 0.3%, P = .51), acute kidney injury (0.7% vs. 0.5%, P = .18), or readmissions (1.2% vs. 1.0%, P = .29). Similarly, no significant differences were found in pulmonary embolism or deep vein thrombosis. Over the 2-year follow-up, TRT use was associated with a higher incidence of total shoulder arthroplasty (0.7% vs. 0.4%, P = .037) but a lower incidence of lysis of adhesions (0.5% vs. 0.9%, P = .032). No significant differences were observed in revision RCR rates (2.6% vs. 2.3%, P = .41). CONCLUSION:Preoperative TRT use was not linked to increased short-term complications after arthroscopic RCR. Over two years, TRT was associated with higher rates of total shoulder arthroplasty but lower rates of lysis of adhesions, with no difference in revision RCR.
BACKGROUND:Olecranon fractures are common injuries and may be indicated for open reduction and internal fixation (ORIF). Surgical techniques include plates and screws, intramedullary screw, Kirschner wire with tension band (KWTB), and all-suture fixation. The purpose of this study was to compare surgical and patient-reported outcomes between these fixation techniques. METHODS:Adult patients who underwent surgery were retrospectively queried (January 2016-December 2020). Demographics, comorbidities, fracture characteristics, surgical details, elbow range of motion (ROM), incidence and time to radiographic healing, reoperations, complications, and patient-reported outcomes were collected. RESULTS:A total of 426 patients met inclusion criteria (plates and screws: 315, intramedullary screw: 27, KWTB: 64, all-suture: 20). Comminuted fractures were predominantly managed using ORIF with plates and screws (45.4%; P < .001). In the postoperative period, KWTB patients experienced hardware loosening (7.81%; P = .049), reoperation (25.0%; P = .031), and delayed radiographic healing (129 ± 226 days; P = .013) at higher rates. Logistic regression demonstrated that comminuted fractures were less likely to be repaired using intramedullary screw fixation or KWTB in comparison with ORIF with plates and screws. Linear regression also found that intramedullary screw fixation was associated with a significant decrease in postoperative elbow extension ROM. CONCLUSIONS:This study found that the 4 surgical techniques for olecranon fracture fixation provided favorable postoperative and patient-reported outcomes while identifying differences in tension band type, fracture characteristics, and complications that may influence surgical decision-making. The otherwise comparable outcomes suggest that surgeons may repair olecranon fractures using their technique of choice without significant additional risk of adverse events.
