BACKGROUND CONTEXT:Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, has shown efficacy in managing glycemic control and obesity but its effects on surgical outcomes, particularly in posterior cervical fusion (PCF), are underexplored. PURPOSE:To evaluate the association between semaglutide use and postoperative complications, costs, and readmissions in patients undergoing PCF. DESIGN:Retrospective cohort study. PATIENT SAMPLE:Patients undergoing PCF were queried from the PearlDiver Mariner database between 2010 and 2022. OUTCOME MEASURES:Outcomes included medical and surgical complications, readmissions, emergency department visits, and associated costs within 90 days and 2 years postoperatively. METHODS:Patients with an active semaglutide prescription were propensity score-matched in a 1:5 ratio to controls based on age, sex, Elixhauser Comorbidity Index, and other clinical variables. Statistical analyses included chi-square tests and logistic regression, with significance set at p<.003 after Bonferroni correction. RESULTS:A total of 340 semaglutide users and 1,540 matched controls were included. Semaglutide use was associated with significantly higher odds of pseudoarthrosis at 2 years (OR 4.79, 95% CI 3.11-7.37; p<.001) and dysphagia (OR 2.12, 95% CI 1.46-3.03; p<.001). Hospital cost analyses revealed significant differences between groups. Same-day ($5,000 vs $11,700; p<.001) and mean 90-day costs were significantly lower ($12,200 vs $18,800; p<.001) in the semaglutide group. No differences were observed in emergency department visits or readmissions (p>.003 for all). CONCLUSIONS:Semaglutide use is associated with an increased risk of long-term complications, including pseudoarthrosis and dysphagia, as well as lower same-day and 90-day costs in patients undergoing PCF. These findings highlight the importance of careful perioperative management of semaglutide users to optimize outcomes while leveraging its purported benefits.

Category: Trauma; Hindfoot Introduction/Purpose: The prevalence of depression is rising globally, and it has been noted in recent literature that the COVID-19 pandemic has exacerbated the increase in depressive disorders. Studies have suggested a strong association between depression and poor outcomes following various orthopedic surgeries, particularly joint arthroplasties. However, depression’s impact on complications following open reduction/internal fixation (ORIF) of Trimalleolar fractures has not been elucidated, despite the high complication rate of this procedure. Therefore, the aims of this study were to determine whether depression is associated with higher rates of 1) readmissions and 2) medical complications following ORIF of Trimalleolar fractures. Methods: Using the Mariner nationwide database from January 1, 2010, to March 31, 2021, a total of 50,154 adults aged 18 or older were identified as having undergone Trimalleolar ORIF using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-9, ICD-10) coding. Patients with depression were matched 1:1 to controls without depression by age, sex, COPD, anxiety, diabetes, hypertension, obesity, and tobacco use. Primary endpoints compared 90-day all-cause readmissions and medical complications. Logistic regression was used to calculate odds-ratios (OR) of the effect of depression on readmissions and medical complications. A p-value of less than 0.05 was significant. Results: Patients with depression who underwent ORIF of Trimalleolar fractures had significantly higher odds of being readmitted within 90-days of the initial procedure (OR: 1.37; 95%CI: 1.27 – 1.48; p< 0.0001). 90-day odds of developing medical complications were significantly higher (OR: 4.61; 95%CI: 4.38 – 4.86; p< 0.0001) in patients with depression compared to patients within the control group. Conclusion: This study demonstrated that patients with depression undergoing Trimalleolar ORIF are at an increased risk of readmission and a multitude of postoperative complications. This information is crucial for orthopedic surgeons considering the already high burden of complications following ORIF of Trimalleolar fractures and increasing prevalence of depression worldwide.

Background:Guyon's Canal Syndrome (GCS) is a rare nerve entrapment condition with limited studies exploring the trends of GCS patients undergoing Guyon's Canal release. The aim of this study is to examine the trends associated with GCS: (1) Guyon's Canal release procedures performed; (2) surgically relevant comorbidities; (3) 90-day readmissions; and (4) same-day and 90-day reimbursement. Methods:A retrospective query was performed on the PearlDiver Mariner Database from 2010 to 2020 by CPT code 64719 to identify patients who underwent Guyon's Canal release. A total of 33,3764 patients were identified. Linear regression models were used to analyze trends in procedures performed, comorbidities, readmission, and reimbursement over this period. A P-value less than 0.05 was considered statistically significant. Results:Between 2010 and 2020, there was an overall significant decreasing trend in the number of Guyon's Canal release procedures performed (RC, -127.50; p < 0.001). There was an increase in number of GCS patients that had undergone Guyon's Canal release who drink alcohol (RC, 0.33; p < 0.001), are obese (RC, 0.81; p < 0.001), and use tobacco (RC, 0.56; p < 0.004), and decrease number of GCS patients with a history of diabetes (RC, -0.82; p < 0.001), hypothyroidism (RC, -0.56; p < 0.001), PVD (RC, -0.71; p < 0.001), and RA (RC, -0.33; p < 0.001). We also found an overall increasing trend in 90-day readmissions (RC, 0.09; p = 0.019) and increased same-day (RC, 68.09; p < 0.001) and 90-day average reimbursement (RC, 257.15; p < 0.001) from 2010 to 2020. Conclusion:The study demonstrated a decreasing trend in Guyon's Canal release performed in GCS patients but increasing cost of care implicated by the increased 90-day readmissions and same day and 90-day reimbursement. This may be attributed to the comorbidities present in GCS patients undergoing Guyon's Canal release. Therefore, it is imperative when consulting GCS patients with surgically relevant comorbidities to weigh the risk and benefits of the procedure.

BACKGROUND CONTEXT While Teriparatide use for osteoporotic patients has been well established, it has not been thoroughly examined among osteopenic patients and those with unremarkable bone health. Patients have shown improved functional outcomes and lower failure rates for lumbar fusion when placed on Teriparatide, but most studies place a generalization on patients with poor bone health. As a result, there is no consensus whether Teriparatide use can specifically improve lumbar fusion success rates in osteopenic patients. PURPOSE The purpose of this study is to compare readmissions, revisions, and complication rates across osteoporotic, osteopenic, and normal bone health patients undergoing primary lumbar fusion with and without Teriparatide. STUDY DESIGN/SETTING N/A PATIENT SAMPLE N/A OUTCOME MEASURES N/A METHODS A PearlDiver Database search query was conducted using International Classifcation of Diseases (ICD) and Current Procedural Terminology (CPT) codes to find patients undergoing primary lumbar fusion with and without Teriparatide, and subclassifying these groups by bone health. This resulted in 4,931 patients who underwent lumbar fusion while previously being on Teriparatide, of which 4,136 were osteoporotic, 239 were osteopenic, and 556 had appropriate bone health. These patients were matched by age, gender, Elixhauser comorbidity index (ECI), obesity, and bisphosphonate use in a 1:5 ratio to lumbar fusion patients who were not using Teriparatide. This resulted in 1,195 osteopenics, 20,680 osteoporotics, and 2,780 appropriate bone health patients in the non-Teriparatide groups. Chi-square analysis was used to compare baseline demographics between operative groups, as well as medical complication, 90-day postoperative readmission, and 2-year revision rates. Logarithmic regression analysis was used to analyze associations between Teriparatide use and associated outcomes. RESULTS Within the teriparatide group, both osteopenic and normal bone health patients had significantly lower rates of 90-day medical complications than the osteoporotic patients (p<0.001). Osteopenic and osteoporotic patients on Teriparatide had similar 90-day readmission rates (23.1% vs 25.1%, respectively, p=0.6239) and 2-year revision rates (35.6% vs 36.8%, p=0.7991). When comparing osteopenic patients using and not using Teriparatide, both groups demonstrated similar medical complication rates, but the Teriparatide group demonstrated lower 90-day readmission rates compared to their non-Teriparatide counterparts (23.1% vs 31.4%, p=0.0099). Logistic regression analysis revealed a lower risk of revisions when osteopenic patients use Teriparatide as opposed to without (OR: 1.54; 99% CI:1.29-1.84; P&lt;0.001). CONCLUSIONS Osteopenic patients using Teriparatide displayed lower medical complication rates compared to osteoporotic patients using Teriparatide, while displaying similar 90-day readmission and 2-year revision rates. Osteopenic patients displayed lower readmission rates and were associated with smaller revision rates following lumbar fusion when on Teriparatide compared to those not using Teriparatide. Surgeons should consider early supplementation of Teriparatide for potential osteopenic lumbar fusion candidates prior to patients reaching osteoporotic status. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs.

INTRODUCTION:Lumbar disk arthroplasty (LDA) is a relatively novel procedure with limited indications and use in the United States, especially relative to lumbar fusion (LF). This study aimed to determine surgical trends between LDA versus LF over the past 10 years to quantify absolute/relative surgical volume over time and compare baseline patient demographics, readmission, 2-year revision rates, and costs-of-care. METHODS:A total of 714,268 patients were identified from a nationwide database who underwent LF (n = 710,527) or LDA (n = 3,741) from 2010 to 2021. The percentage of patients managed by each surgical procedure was calculated overall and subdivided annually. Baseline demographics were compared between surgical groups, comparing postoperative readmission rates and 2-year revision rates. Linear regression modeling was done to evaluate trends/differences in procedural volume by year. RESULTS:Beginning in 2010 to 2011, LDA constituted 1.0% of procedures, before the number/proportion of LDA procedures to LF has slowly dropped (1% in 2010 to 0.6% in 2021, P > 0.05). Patients undergoing LDA were younger (42.7 vs. 60.9 years, P < 0.0001) with a higher male proportion (50.9 vs. 42.8, P < 0.0001) and a lower Elixhauser Comorbidity Index (2.5 vs. 4.6, P < 0.0001). Patients undergoing LDA had lower rates of readmission (3.8 vs. 7.6%, P < 0.0001). Both LDA and LF average same-day reimbursements elevated sharply from 2010 to 2015 before decreasing to values lower than initially at 2010, with LF demonstrating a greater reduction in costs ($10,600 vs. $2,600, P < 0.05), although LDA remains cheaper ($2,900 vs. $5,300, P < 0.05). CONCLUSION:The surgical volume of LDA has remained steady while dropping in proportion relative to LF over the past decade. Although patients undergoing LDA are younger and have both fewer baseline demographic comorbidities and lower readmission rates, surgeons remain hesitant to perform this procedure over LF. STUDY DESIGN:Retrospective Cohort Study, Level III Evidence.

Category: Hindfoot; Trauma Introduction/Purpose: Calcaneal fractures, commonly caused by high-energy trauma, present significant challenges for orthopedic surgeons. Open reduction internal fixation (ORIF) is a widely used surgical technique for managing these fractures; it can lead to subtalar joint arthritis and pain, requiring subtalar fusion when conservative treatments prove ineffective. Understanding the risk factors associated with subtalar fusion (STF) after calcaneal ORIF is crucial for optimizing patient outcomes and treatment strategies. In this study, we aimed to comprehensively evaluate these risk factors, including patient demographics, medical comorbidities, same day and 90-day reimbursement data. Methods: A retrospective analysis was performed using the PearlDiver Mariner 157 national claims database from January 1st, 2010 to October 31st, 2021. Patients who underwent calcaneal ORIF, identified using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-9, ICD-10) codes, were queried for 5-year rates of STF and reimbursement data. Patient demographics and comorbidities were recorded, and multivariate logistic regression was employed to determine the association of risk factors with STF. A p-value of less than 0.001 was considered significant after performing a Bonferroni correction. Results: Patients with STF had a higher proportion of alcohol abuse (21.3% vs. 16.2%), depression (58.1% vs. 43.1%), drug abuse (29.1% vs. 19.7%), obesity (40.3% vs. 28%) and tobacco use (62.2% vs. 50.3%), all exhibiting a p-value of less than 0.001. Those with depression (OR: 1.54; 99% CI:1.29-1.84; p< 0.001) and obesity (OR:1.58; 99% CI: 1.32-1.88; p< 0.001) as comorbidities had a higher odds ratio of association ith STF within 5 years following calcaneal ORIF. Conclusion: Our study demonstrates that patients who ultimately required STF within 5 years of calcaneal ORIF had higher rates of alcohol abuse, tobacco use, drug use, obesity, and depression prior to ORIF. In addition, there was no significant difference observed between those with and without STF in average same-day and 90-day reimbursements and demographics. Future patients with a calcaneal fracture along with multiple risk factors listed above should be in consideration for primary surgical fusion over calcaneal ORIF, with additional studies needed to aid orthopaedic surgeons in this decision making.

Purpose:The purpose of this study was to determine whether the rates of (1) in-hospital lengths of stay (LOS), (2) readmissions, (3) medical complications, and (4) costs of care are higher for patients with depressive disorder (DD) undergoing primary total hip arthroplasty (THA) for treatment of femoral neck fractures (FNFs). Materials and Methods:A retrospective query of a national administrative claims database for patients undergoing primary THA from 2006 to 2014 was conducted. Patients with DD undergoing THA for treatment of FNF were 1:5 ratio propensity score matched to a cohort (DD=6,758, controls=33,708). Primary endpoints included LOS, 90-day medical complications, 90-day readmissions, and healthcare reimbursements. A P-value less than 0.05 was considered statistically significant. Results:Longer LOS were observed for patients with DD compared to those without DD (5.6 days vs. 5.4 days, P<0.001). Similar readmission rates (29.9% vs. 25.0%, odds ratio [OR] 1.03, P=0.281) were observed between groups. The odds of 90-day medical complications were higher for patients with DD compared to control subjects (60.6% vs. 21.4%, OR 1.57, P<0.0001). Within the 90-day episode of care interval, patients with a history of DD incurred significantly higher healthcare expenditures ($21,382 vs. $19,781, P<0.001). Conclusion:Our findings showed longer LOS, higher odds of 90-day medical complications, and higher healthcare expenditures within the 90-day episode of care following a primary THA for treatment of FNF for patients with DD compared to the matched cohort. Thus, accordingly, patients with DD should receive counseling prior to undergoing surgery.

Background Cementless total knee arthroplasty (TKA) has received growing interest, particularly in younger populations, due to potential long-term survivability and improved bone preservation. Poor bone stock, as seen in osteoporosis, is considered a contraindication for this technique. This study evaluated whether osteoporotic patients < 75 years undergoing cementless TKA demonstrate similar: 1) implant-related complications, 2) medical complications, 3) readmission rates, and 4) 3-year implant survivability. Methods A retrospective query of a national administrative claims database was performed between 2010 and 2022 for patients less than or equal to 75 years old who have osteoporosis and underwent primary TKA. Osteoporotic patients were divided into cementless and cemented cohorts, and propensity scores were matched based on age, sex, obesity, and the Charlson Comorbidity Index. Matching produced 7,923 patients (1,321 uncemented, 6,602 cemented). Multivariate logistic regressions evaluated the following outcomes: 90-day and 2-year implant-related complications, 90-day postoperative medical complications, and 90-day readmissions. Kaplan-Meier survival analysis was conducted to assess 3-year all-cause revision implant survivability. The significance threshold was set to P < 0.01 to minimize type 1 bias. Results There were no statistically significant differences in implant-related complications, medical complications, readmissions, and lengths of stay between cementless and cemented TKA groups. Kaplan-Meier analysis demonstrated statistically similar 3-year survivability between cohorts (cemented: 97.6%, confidence interval 96.6 to 98.5; cementless: 97.2%, confidence interval 96.7 to 97.7; P = 0.472). Conclusions Patients who have osteoporosis have equivalent medical and implant-related complications as well as 3-year implant survival following cementless TKA compared with a cemented technique. Our results support cementless TKA as a viable option for patients < 75 years, regardless of prior diagnosis of osteoporosis. Intraoperative decisions regarding bone quality are still necessary to discriminate between those who are candidates for cementless TKA with those who are not. Level of Evidence Level III, Retrospective cohort study.