다중혈관 관상동맥 환자에서 y-문합을 이용하여 양쪽 내흉동맥만을 사용한 우회술의 조기 성적

This is an announcement. AAOS update of The Burden of Musculoskeletal Diseases in the United States.

The Burden of Musculoskeletal Diseases in the United States

Objectives To examine one health system's response to the essential care of its hip fracture population during the COVID-19 pandemic and report on its effect on patient outcomes. Design Prospective cohort study. Setting Seven musculoskeletal care centers within New York City and Long Island. Patients/participants One hundred thirty-eight recent and 115 historical hip fracture patients. Intervention Patients with hip fractures occurring between February 1, 2020, and April 15, 2020, or between February 1, 2019, and April 15, 2019, were prospectively enrolled in an orthopaedic trauma registry and chart reviewed for demographic and hospital quality measures. Patients with recent hip fractures were identified as COVID positive (C+), COVID suspected (Cs), or COVID negative (C-). Main outcome measurements Hospital quality measures, inpatient complications, and mortality rates. Results Seventeen (12.2%) patients were confirmed C+ by testing, and another 14 (10.1%) were suspected (Cs) of having had the virus but were never tested. The C+ cohort, when compared with Cs and C- cohorts, had an increased mortality rate (35.3% vs. 7.1% vs. 0.9%), increased length of hospital stay, a greater major complication rate, and a greater incidence of ventilator need postoperatively. Conclusions COVID-19 had a devastating effect on the care of patients with hip fracture during the pandemic. Although practice patterns generally remained unchanged, treating physicians need to understand the increased morbidity and mortality in patients with hip fracture complicated by COVID-19. Level of evidence Prognostic Level III. See Instructions for Authors for a complete description of Levels of Evidence.

/pdf/increased-mortality-and-major-complications-in-hip-fracture-2zn12acggw.pdf

Increased Mortality and Major Complications in Hip Fracture Care During the COVID-19 Pandemic: A New York City Perspective.

BACKGROUNDElderly trauma patients have outcomes worse than those of similarly injured younger patients. Although patient age and comorbidities explain some of the difference, the contribution of frailty to outcomes is largely unknown because of the lack of assessment tools developed specifically to

Frailty in Trauma: A Systematic Review of the Surgical Literature for Clinical Assessment Tools

Objectives (1) To demonstrate how a risk assessment tool modified to account for the COVID-19 virus during the current global pandemic is able to provide risk assessment for low-energy geriatric hip fracture patients. (2) To provide a treatment algorithm for care of COVID-19 positive/suspected hip fractures patients that accounts for their increased risk of morbidity and mortality. Setting One academic medical center including 4 Level 1 trauma centers, 1 university-based tertiary care referral hospital, and 1 orthopaedic specialty hospital. Patients/participants One thousand two hundred seventy-eight patients treated for hip fractures between October 2014 and April 2020, including 136 patients treated during the COVID-19 pandemic between February 1, 2020 and April 15, 2020. Intervention The Score for Trauma Triage in the Geriatric and Middle-Aged ORIGINAL (STTGMAORIGINAL) score was modified by adding COVID-19 virus as a risk factor for mortality to create the STTGMACOVID score. Patients were stratified into quartiles to demonstrate differences in risk distribution between the scores. Main outcome measurements Inpatient and 30-day mortality, major, and minor complications. Results Both STTGMA score and COVID-19 positive/suspected status are independent predictors of inpatient mortality, confirming their use in risk assessment models for geriatric hip fracture patients. Compared with STTGMAORIGINAL, where COVID-19 patients are haphazardly distributed among the risk groups and COVID-19 inpatient and 30 days mortalities comprise 50% deaths in the minimal-risk and low-risk cohorts, the STTGMACOVID tool is able to triage 100% of COVID-19 patients and 100% of COVID-19 inpatient and 30 days mortalities into the highest risk quartile, where it was demonstrated that these patients have a 55% rate of pneumonia, a 35% rate of acute respiratory distress syndrome, a 22% rate of inpatient mortality, and a 35% rate of 30 days mortality. COVID-19 patients who are symptomatic on presentation to the emergency department and undergo surgical fixation have a 30% inpatient mortality rate compared with 12.5% for patients who are initially asymptomatic but later develop symptoms. Conclusion The STTGMA tool can be modified for specific disease processes, in this case to account for the COVID-19 virus and provide a robust risk stratification tool that accounts for a heretofore unknown risk factor. COVID-19 positive/suspected status portends a poor outcome in this susceptible trauma population and should be included in risk assessment models. These patients should be considered a high risk for perioperative morbidity and mortality. Patients with COVID-19 symptoms on presentation should have surgery deferred until symptoms improve or resolve and should be reassessed for surgical treatment versus definitive nonoperative treatment with palliative care and/or hospice care. Level of evidence Prognostic Level III. See Instructions for Authors for a complete description of Levels of Evidence.

Modification of a Validated Risk Stratification Tool to Characterize Geriatric Hip Fracture Outcomes and Optimize Care in a Post-COVID-19 World.

Introduction:Frailty in elderly trauma populations has been correlated with an increased risk of morbidity and mortality. The Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA) is a validated mortality risk score that evaluates 4 major physiologic criteria: age, comorbidities, vital signs, and anatomic injuries. The aim of this study was to investigate whether the addition of additional frailty variables to the STTGMA tool would improve risk stratification of a middle-aged and elderly trauma population.Methods:A total of 1486 patients aged 55 years and older who met the American College of Surgeons Tier 1 to 3 criteria and/or who had orthopedic or neurosurgical traumatic consultations in the emergency department between September 2014 and September 2016 were included. The STTGMAORIGINAL and STTGMAFRAILTY scores were calculated. Additional “frailty variables” included preinjury assistive device use (disability), independent ambulatory status (functional independence), and albumin level (nutr...

https://journals.sagepub.com/doi/pdf/10.1177/2151458517735202

How Does Frailty Factor Into Mortality Risk Assessment of a Middle-Aged and Geriatric Trauma Population?

AIM
To review and report functional outcomes, complications, and survivorship associated with total knee arthroplasty (TKA) in the treatment of post-traumatic arthritis (PTA).

Total knee arthroplasty for treatment of post-traumatic arthritis: Systematic review.

Objectives To determine whether a novel inpatient mortality risk assessment tool designed to be calculated in the emergency department setting can risk stratify patient-reported functional outcomes and mortality at 1 year. Design Prospective cohort. Setting Academic level 1 trauma center. Patients Six hundred eight-five patients >55 years of age who were orthopaedic surgery consults or trauma surgery consults in the emergency department between January 10, 2014, and September 30, 2015. Intervention Calculation of the validated score for trauma triage in the geriatric and middle-aged (STTGMA) using each patient's demographics, injury severity, and functional status. Main outcome measurements Mortality, EQ-5D questionnaire, and percent return to baseline function since their hospitalization at 1-year after hospitalization. Results Forty-five (6.6%) patients died within the year after hospitalization. Of remaining 639 patients available for follow-up, 247 (38.7%) were successfully contacted. There was no observed difference between patients who were successfully contacted and those who were not. The mean STTGMA score was 2.1% ± 3.6%. Patients reported on average a 76.4% ± 27.5% return to baseline function. When comparing patients between risk groups, there was a significant difference in EQ-5D scores and percent return to baseline. The Kaplan-Meier survival curve shows that high-risk patients had pronounced decreased survival within the initial days after discharge compared with other cohorts. Conclusions This study demonstrates that patients identified with the STTGMA tool as having an increased risk of inpatient mortality after trauma correlate with poorer functional outcomes at 1 year. The STTGMA risk score is also a valuable tool to stratify risk of mortality up to 1 year after discharge. Level of evidence Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Use of the STTGMA Tool to Risk Stratify 1-Year Functional Outcomes and Mortality in Geriatric Trauma Patients.

Patterns of discharge location may be evident based on the “sickness” profile of the patient. This study sought to evaluate the ability of the STTGMA tool, a validated mortality risk index for middle-aged and geriatric trauma patients, to predict discharge location in a cohort of low-energy elderly hip fracture patients, with successful discharge planning measured by readmission rates. Low-energy hip fracture patients aged 55 years and older were prospectively followed throughout their hospitalization. On initial evaluation in the Emergency Department, each patient’s age, comorbidities, injury severity, and functional status were utilized to calculate a STTGMA score. Discharge location was recorded with the primary outcome measure of an unsuccessful discharge being readmission within 30 days. Patients were risk stratified into minimal-, low-, moderate-, and high-risk STTGMA cohorts. A p-value of <0.05 was considered significant for all statistical tests. 408 low-energy hip fractures were enrolled in the study with a mean age of 81.3±10.6 years. There were 214 (52.5%) intertrochanteric fractures, 167 (40.9%) femoral neck fractures, and 27 (6.6%) subtrochanteric femur fractures. There was no difference in readmission rates within STTGMA risk cohorts with respect to discharge location; however, among individual discharge locations there was significant variation in readmission rates when patients were risk stratified. Overall, STTGMA risk cohorts appeared to adequately risk-stratify readmission with 3.5% of minimal-risk patients experiencing readmission compared to 24.5% of moderate-risk patients. Specific cohorts deemed high-risk for readmission were adequately identified. The STTGMA tool allows for prediction of unfavorable discharge location in hip fracture patients. Based on observations made via the STTGMA tool, improvements in discharge planning can be undertaken to increase home discharge and to more closely track “high-risk” discharges to help prevent readmissions.

/pdf/predicting-discharge-location-among-low-energy-hip-fracture-57jku5pgte.pdf

Predicting Discharge Location among Low-Energy Hip Fracture Patients Using the Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA)

Objectives To investigate the efficacy of a novel geriatric trauma risk assessment tool [Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA)] designed to predict inpatient mortality to risk-stratify measures of hospital quality and cost of care in middle-aged and geriatric orthopaedic trauma patients. Design Prospective cohort study. Setting Academic medical center. Patients One thousand five hundred ninety-two patients 55 years of age and older who were evaluated by orthopaedic surgery in the emergency department between October 1, 2014, and September 30, 2016. Intervention Calculation of the inpatient mortality risk score (STTGMA) using each patient's demographics, injury severity, and functional status. Patients were stratified into minimal-, low-, moderate-, and high-risk cohort groups based on risk of 5%. Main outcome measurements Length of stay, complications, disposition, readmission, and cost. Results One thousand two hundred seventy-eight patients (80.3%) sustained low-energy injuries and 314 patients (19.7%) sustained high-energy injuries. The average age was 73.8 ± 11.8 years. The mean length of hospital stay was 5.2 days with a significant difference between the STTGMA risk groups. This risk stratification between groups was also seen in complication rate, need for Intensive Care Unit/Step Down Unit care, percentage of patients discharged, and readmission within 30-days. The mean total cost of admission for the minimal-risk group was less than one-third that of the high-risk cohort. Conclusions The STTGMA tool is able to risk-stratify hospital quality outcome measures and cost. Thus, it is a valuable clinical tool for health care providers in identifying high-risk patients in efforts to continue to provide high-quality resource conscious care to orthopaedic trauma patients. Level of evidence Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Using Trauma Triage Score to Risk-Stratify Inpatient Triage, Hospital Quality Measures, and Cost in Middle-Aged and Geriatric Orthopaedic Trauma Patients.

Hesham Saleh

Papers

How Does Frailty Factor Into Mortality Risk Assessment of a Middle-Aged and Geriatric Trauma Population?

Total knee arthroplasty for treatment of post-traumatic arthritis: Systematic review.

Use of the STTGMA Tool to Risk Stratify 1-Year Functional Outcomes and Mortality in Geriatric Trauma Patients.

Predicting Discharge Location among Low-Energy Hip Fracture Patients Using the Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA)

Using Trauma Triage Score to Risk-Stratify Inpatient Triage, Hospital Quality Measures, and Cost in Middle-Aged and Geriatric Orthopaedic Trauma Patients.