The Cost-Effectiveness of Smoking Cessation Programs for Prevention of Wound Complications Following Total Ankle Arthroplasty: A Break-Even Analysis
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SUBMITTER: Kim A
PROVIDER: S-EPMC10952985 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:IntroductionThis technique guide is intended to help surgeons to avoid pitfalls and optimize the surgical technique for implantation of a total ankle prosthesis.Step 1 preoperative planningObtain radiographs and other relevant images and perform accurate templating.Step 2 patient positioningPosition the patient with the foot and patella facing directly forward, and mark the anterior tibial crest.Step 3 surgical approachIncise the ankle, taking care to avoid injury to the superficial peroneal nerve and to protect the deep neurovascular bundle.Step 4 bone cuts and component implantationMake the bone cuts in the distal part of the tibia and the talar dome, taking care to avoid excessive bone resection from the distal part of the tibia, fracture of the malleoli, or penetrating too deeply.Step 5 soft-tissue balancingMake adjustments as needed for optimal range of motion, alignment, and joint balancing; then remove the trial components and insert the final components.Step 6 wound closureRepair the extensor retinaculum and close the wound, taking measures that help avoid wound-related complications.Results & preop/postop imagesDespite careful patient selection and surgical technique in our series of 106 consecutive total ankle arthroplasties performed with the Agility system, twenty-seven ankles (25%) had problems related to the anterior incision that required local wound care or oral antibiotics and then healed without subsequent consequences.What to watch forIndicationsContraindicationsPitfalls & Challenges.
| S-EPMC7821969 | biostudies-literature
Project description:BackgroundDespite limited evidence, peripheral vascular disease is often cited as a contraindication for total ankle arthroplasty. The purpose of our study was to identify whether peripheral vascular disease in patients undergoing total ankle arthroplasty increased the rate of infection, postoperative irrigation and debridement, or failure of the implant.MethodsThe PearlDiver Database was used to identify Medicare patients who underwent a total ankle arthroplasty from 2005 to 2014. These data were then analyzed for postoperative infections within 90 days, subsequent irrigation and debridements, and failure of total ankle arthroplasties. A diagnosis of preoperative peripheral vascular disease only included those patients who had peripheral vascular disease as an ICD-9 diagnosis code and underwent a preoperative lower extremity angiogram prior to total ankle arthroplasty. Medical comorbidities were identified using ICD-9 diagnosis codes. Three multivariable logistic regression models were then developed in order to identify risk factors associated with postoperative infections and failure after total ankle arthroplasty.ResultsA total of 10 698 Medicare patients who underwent a primary total ankle arthroplasty were identified. There were 334 patients who had a postoperative infection within 90 days of their total ankle arthroplasty, and 95 of those patients required an irrigation and debridement. Regression analysis demonstrated that patients with peripheral vascular disease had the greatest risk of developing a postoperative infection within 90 days (OR 2.85, P < .01), requiring an irrigation and debridement postoperatively (OR 4.87, P < .001), and having a total ankle arthroplasty failure at any time point postoperatively (OR 2.51, P < .001).ConclusionsOur study suggests that preoperative peripheral vascular disease is a significant risk factor for an acute postoperative infection, postoperative irrigation and debridement, and failure of the implant in Medicare patients undergoing a total ankle arthroplasty.Level of evidenceLevel III, therapeutic.
| S-EPMC8696873 | biostudies-literature
Project description:BackgroundIn patients with total elbow arthroplasty (TEA), the soft-tissue around the elbow can be vulnerable to soft-tissue complications. This study aims to assess the outcomes after soft-tissue reconstruction following TEA.MethodsWe retrospectively included nine adult patients who underwent soft-tissue reconstruction following TEA. Demographic data and disease characteristics were collected through medical chart reviews. Additionally, we contacted all four patients that were alive at the time of the study by phone to assess any current elbow complications. Local tissue rearrangement was used for soft-tissue reconstruction in six patients, and a pedicle flap was used in three patients. The median follow-up period was 1.3 years (range, 6 months-14.7 years).ResultsSeven patients (78%) underwent reoperation. Four patients (44%) had a reoperation for soft-tissue complications, including dehiscence or nonhealing of infected wounds. Five patients (56%) had a reoperation for implant-related complications, including three infections and two peri-prosthetic fractures. At the final follow-ups, six patients (67%) achieved successful wound healing and two patients had continued wound healing issues, while two patients had an antibiotic spacer in situ and one patient underwent an above-the-elbow amputation.ConclusionsThis study reports a complication rate of 78% for soft-tissue reconstructions after TEA. Successful soft-tissue healing was achieved in 67% of patients, but at the cost of multiple surgeries. Early definitive soft-tissue reconstruction could prove to be preferable to minor interventions such as irrigation, debridement, and local tissue advancement, or smaller soft-tissue reconstructions using local tissue rearrangement or a pedicled flap at a later stage.
| S-EPMC8651597 | biostudies-literature
Project description:BackgroundSurgeons who lack experience with total ankle arthroplasty (TAA) may remain hesitant to introduce this procedure owing to previously published results of high complication rates during initial cases. The purpose of the present study was to report the development of a TAA program through intermediate outcomes and complications for an initial consecutive series of TAA patients of a single community-based foot and ankle fellowship-trained orthopedic surgeon with little TAA experience using a co-surgeon with similar training and TAA exposure.MethodsThe initial 20 patients following third-generation TAA with a single surgeon were reviewed. Clinical outcomes were measured and radiographs were evaluated to determine postoperative implant and ankle position. Complications were also measured including intraoperative, early (<3 months), and intermediate postoperative complications.ResultsWith a minimum follow-up of 2 years and average follow-up of 51 months (range 24-70 months), the mean American Orthopaedic Ankle & Foot Society Ankle-Hindfoot score was 87.7 (59-100) and VAS was 1.0 (0-5.5). All patients were improved following TAA. Radiographic evaluation demonstrated no evidence of component malalignment or ankle joint incongruity. There were no intraoperative complications nor any wound complications. Three patients returned to the operating room for placement of medial malleolar screw placement, and 1 had asymptomatic tibial component subsidence.ConclusionsOrthopedic surgeons with a proper background and updated training may be able to perform TAA with good outcomes. A TAA program was developed to define minimum training criteria to perform this procedure in our community. Our complication rate is consistent with those reported in the literature for experienced TAA centers, which contrasts previous literature suggesting increased complication rates and worse outcomes when surgeons perform initial TAAs. Utilization of an orthopedic co-surgeon was felt to be instrumental in the success of the program.Level of evidenceLevel IV, retrospective case series.
| S-EPMC8702896 | biostudies-literature
Project description:Financial incentives offered to those who quit smoking have been found effective, also in persons with low socioeconomic status (SES), but no previous study has investigated who benefits most: smokers with low or high SES. In this community-randomized trial ("Richer without smoking"), three Danish municipalities were randomized to reward persons who were abstinent when attending the municipal smoking cessation program (FIMs) and three municipalities were randomized to spend the same amount on smoking cessation campaigns recruiting smokers to the smoking cessation program (CAMs). The municipalities each received approximately USD 16,000. An intention-to-treat approach was used in analyses. In regression analyses adjusted for individual- and municipal-level differences, we found that smokers with high SES living in FIMs had significantly higher proportion of validated long-term successful quitters (OR (95% CI): 2.59 (1.6-4.2)) than high-SES smokers living in CAM. Smokers with low SES, however, did not experience the same benefit of financial incentives as smokers with high SES. Neither the FIMs nor the CAMs succeeded in attracting more smokers with low SES during the intervention year 2018 than the year before. Our study showed that smokers with low SES did not experience the same benefit of financial incentives as smokers with high SES.
| S-EPMC9518409 | biostudies-literature
Project description:BackgroundWith an increasing volume of primary total shoulder arthroplasties (TSA), the number of revision TSA cases is expected to increase as well. However, the postoperative medical morbidity of revision TSA has not been clearly described.Questions/purposesThe purpose of this study was to determine the rate of postoperative complications following revision TSA, relative to primary TSA. In addition, we sought to identify independent predictors of complications, as well as to compare operative time and postoperative length of stay between primary and revision TSA.MethodsPatients who underwent primary/revision TSA between 2005 and 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program. Differences in complications, readmission rates, operative time, length of stay, and predictors of complications were evaluated using bivariate and multivariate analyses.ResultsA total of 10,371 primary TSA (95.4%) and 496 revision TSA cases (4.6%) were identified. The overall complication rate was 6.5% in primary and 10.7% in revision TSA patients (p < 0.001). Multivariate analysis identified an increased risk of any complication (odds ratio 1.73, p < 0.001), major complication (2.08, p = 0.001), and wound infection (3.45, p = 0.001) in revision TSA patients, relative to primary cases. Operative time was increased in revision cases (mean ± standard deviation, 125 ± 62.5), relative to primary (115 ± 47.7, p < 0.001). Age > 75, female sex, history of diabetes or chronic obstructive pulmonary disease, and American Society of Anesthesiologists classification ≥ 3 were associated with increased risk of any complication. Smoking history was the only significant predictor of wound infection.ConclusionRevision TSA, in comparison to primary, poses an increased risk of postoperative complications, particularly wound infections. A history of smoking was an independent predictor of wound infections.
| S-EPMC5786585 | biostudies-literature
Project description:Accurate positioning of the total ankle arthroplasty implant components with the absence of any hindfoot deformity does not preclude the development of bony impingement. In cases of ankle stiffness after total ankle arthroplasty, the usual limitation is in dorsiflexion. If triceps surae contracture is excluded or persistent restriction remains in ankle dorsiflexion after gastrocnemius recession or tendo-Achilles lengthening, posterior ankle capsulectomy, debridement of posterior ankle gutter, and release of the deep posterior deltoid ligament and the posterior talofibular ligament are indicated. In this Technical Note, the technical details of endoscopic posterior ankle decompression and release after total ankle arthroplasty are described.
| S-EPMC9134246 | biostudies-literature
Project description:Total ankle arthroplasty (TAA) is gaining in popularity, with the main objective to restore a pain-free mobile and stable ankle and is hoped to solve the long-term problems associated with ankle arthrodesis. Residual pain is not uncommon after TAA, and most is located at the medial gutter with bony impingement as the frequent cause. In this Technical Note, the technical details of arthroscopic decompression for medial ankle impingement after total ankle arthroplasty is described. It has the advantage of earlier weightbearing, faster recovery and less risk of periprosthetic infection.
| S-EPMC8185646 | biostudies-literature
Project description:BackgroundObesity is prevalent among patients undergoing total hip arthroplasty and has been associated with the risk of wound complications, particularly when an anterior approach is used. However, most studies have focused on obesity defined by the body mass index (BMI), without considering the metabolic effects of adiposity. Thus, in this study, we investigated the independent effects of the BMI and metabolic syndrome on wound complications after total hip arthroplasty.MethodsAmong 804 consecutive patients undergoing total hip arthroplasty between October 2013 and July 2016, we evaluated the associations between obesity (BMI ≥30 mg/kg2), metabolic syndrome (defined by the National Cholesterol Education Program Adult Treatment Panel III guidelines), and wound complication (defined as documented wound dehiscence, drainage, erythema, hematoma, infection, or seroma) over a 1-year follow-up period. We used Cox proportional hazards models adjusting for demographics, smoking status, and hospital length of stay.ResultsPatients' mean age at time of surgery was 62.0 ± 11.9 years. Forty-seven percent were male, 27.9% were obese, and 11.6% met the definition for metabolic syndrome. Metabolic syndrome was associated with a 4-fold higher risk of wound complication (95% confidence interval: 1.4-11.1) after adjusting for all covariates including the BMI. In unadjusted analysis, obesity was associated with a higher risk of wound complication (hazard ratio: 2.8, 95% confidence interval: 1.3-6.2). However, obesity was not associated with the risk of wound complication after adjusting for the metabolic syndrome (P = .16).ConclusionsMetabolic syndrome, but not obesity, defined by a BMI ≥30, was associated with wound complications, suggesting that metabolic effects of adiposity may represent a distinct risk factor in the development of wound complications from a higher BMI alone.
| S-EPMC7419251 | biostudies-literature
Project description:Background Hidradenitis suppurativa (HS) is a skin disorder characterized by inflammatory skin lesions that are most commonly in the inguinal and axillary regions. These skin lesions are common sites of bacterial growth and are thus a potential risk factor for infection following procedures such as total hip arthroplasty (THA) or total knee arthroplasty (TKA). Material and methods Adult patients undergoing THA or TKA for degenerative etiologies were identified from PearlDiver datasets. For THA and TKA, HS patients were matched 1:4 with non-HS patients based on age, sex, and Elixhauser Comorbidity Index. The incidence of 90-day any, severe, minor, and specific adverse events was compiled and compared with multivariate analyses. Five-year revision rates were plotted on Kaplan-Meier survival curves and compared with log-rank tests. Results For THA, 331,627 patients were identified, of which HS was noted for 481 patients (0.15%). For TKA, 274,161 patients were identified, of which HS was noted for 290 patients (0.11%). Following THA, HS patients had increased odds of wound dehiscence (odds ratio = 2.55, P = .002). Following TKA, HS patients had increased odds of surgical site infection (odds ratio = 1.95, P = .006). All other 90-day adverse events were not significantly different. There was no significant difference in 5-year implant survival in either procedure. Conclusions HS is a rare but identified comorbidity for those undergoing THA or TKA. Although most 90-day adverse events and 5-year implant survival were similar to those without this condition, specific wound-related issues were elevated by roughly twofold. These findings could help inform patients and surgeons.
| S-EPMC9249970 | biostudies-literature