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2. Mortality, perioperative complications and surgical timelines in hip fracture patients: Comparison of the Spanish with the non-Spanish Cohort of the HIP ATTACK-1 trial

Author

Veevaete, Laurent, Waroux, Bernard le Polain de, Lavand'homme, Patricia, Cornu, Olivier, Tribak, Karim, Yombi, Jean C, Touil, Nassim, Bhutia, Jigme T, Clinckaert, Carol, Clippeleir, Dirk De, Reul, Maike, Patel, Ameen, Tandon, Vikas, Gauthier, Leslie P, Avram, Victoria R.A., Winemaker, Mitchell, de Beer, Justin, Simpson, Diane L, Worster, Andrew, Alvarado, Kim A, Gregus, Krysten K, Lawrence, Kelly H, Leong, Darryl P, Joseph, Philip G, Magloire, Patrick, Deheshi, Benjamin, Bisland, Stuart, Wood, Thomas J, Tushinski, Daniel M., Wilson, David A.J., Haider, Shariq, Bali, Kamal, Kearon, Clive, Manach, Yannick Le, Adili, Anthony, Tiboni, Maria E, Neary, John D, Cowan, David D, Khanna, Vickas, Zaki, Amna, Farrell, Janet C, MacDonald, Anne Marie, Conen, David, Wong, Steven C.W., Karbassi, Arsha, Wright, Douglas S, Shanthanna, Harsha, Coughlin, Ryan, Khan, Moin, Wikkerink, Spencer, Quraishi, Faraaz A, Lawendy, Abdel-Rahman, Kishta, Waleed, Schemitsch, Emil, Carey, Timothy, Macleod, Mark D, Sanders, David W, Vasarhelyi, Edward, Bartley, Debra, Dresser, George K, Tieszer, Christina, Jenkinson, Richard J, Shadowitz, Steven, Lee, Jacques S, Choi, Stephen, Kreder, Hans J, Nousiainen, Markku, Kunz, Monica R, Tuazon, Ravianne, Shrikumar, Mopina, Ravi, Bheeshma, Wasserstein, David, Stephen, David J.G., Nam, Diane, Henry, Patrick D.G., Wood, Gavin C.A., Mann, Stephen M., Jaeger, Melanie T., Sivilotti, Marco L.A., Smith, Christopher A., Frank, Christopher C., Grant, Heather, Ploeg, Leone, Yach, Jeff D., Harrison, Mark M., Campbell, Aaron R., Bicknell, Ryan T., Bardana, Davide D., Feibel, Robert J., McIlquham, Katie, Gallant, Catherine, Halman, Samantha, Thiruganasambandamoorth, Venkatesh, Ruggiero, Sara, Hadden, William J., Chen, Brian P.J., Coupal, Stephanie A., McMahon, Stephen J., McLean, Lisa M., Shirali, Hemant R., Haider, Syed Y., Smith, Crystal A., Watts, Evan, Santone, David J., Koo, Kevin, Yee, Allan J., Oyenubi, Ademilola N., Nauth, Aaron, Schemitsch, Emil H., Daniels, Timothy R., Ward, Sarah E., Hall, Jeremy A., Ahn, Henry, Whelan, Daniel B., Atrey, Amit, Khoshbin, Amir, Puskas, David, Droll, Kurt, Cullinan, Claude, Payendeh, Jubin, Lefrancois, Tina, Mozzon, Lise, Marion, Travis, Jacka, Michael J., Greene, James, Menon, Matthew, Stiegelmahr, Robert, Dillane, Derek, Irwin, Marleen, Beaupre, Lauren, Coles, Chad P., Trask, Kelly, MacDonald, Shelley, Trenholm, J.A.I., Oxner, William, Richardson, C.G., Dehghan, Niloofar, Sadoughi, Mehdi, Sharma, Achal, White, Neil J., Olivieri, Loretta, Hunt, Stephen B., Turgeon, Thomas R., Bohm, Eric R., Tran, Sarah, Giilck, Stephen M., Hupel, Tom, Guy, Pierre, O'Brien, Peter J., Duncan, Andrew W., Crawford, Gordon A., hou, Junlin, Zhao, Yanrui, Liu, Yang, Shan, Lei, Wu, Anshi, Muñoz, Juan M., Chaudier, Philippe, Douplat, Marion, Fessy, Michel Henri, Piriou, Vincent, Louboutin, Lucie, David, Jean Stephane, Friggeri, Arnaud, Beroud, Sebastien, Fayet, Jean Marie, Landais, Paul, Leung, Frankie Ka Li, Fang, Christian Xinshuo, Yee, Dennis King Hang, Sancheti, Parag K., Pradhan, Chetan V., Patil, Atul A., Puram, Chetan P., Borate, Madhav P., Kudrimoti, Kiran B., Adhye, Bharati A., Dongre, Himanshu V., John, Bobby, Abraham, Valsamma, Pandey, Ritesh A., Rajkumar, Arti, George, Preetha E., Sigamani, Alen, Stephen, Manesh, Chandran, Nitheesh, Ashraf, Mohammed, Georgekutty, A.M., Sulthan, Ahamad S., Adinarayanan, S., Sharma, Deep, Barnawal, Satish P., Swaminathan, Srinivasan, Bidkar, Prasanna U., Mishra, Sandeep K., Menon, Jagdish, M, Niranjan, Zk, Varghese, Hiremath, Santosh A., Nc, Madhusudhan, Jawali, Abhijit, Gnanadurai, Kingsly R., George, Carolin E., Maddipati, Atarao, Kp, Mary, Sharma, Vijay, Farooque, Kamran, Malhotra, Rajesh, Mittal, Samarth, Sawhney, Chavi, Gupta, Babita, Mathur, Purva, Gamangati, Shivanand, Tripathy, Vijaylaxmi, Menon, Prem H., Dhillon, Mandeep S., Chouhan, Devendra K., Patil, Sharanu, Narayan, Ravi, Lal, Purushotham, Bilchod, Prashanth N., Singh, Surya U., Gattu, Uttam V., Dashputra, Ravi P., Rahate, Prashant V., Turiel, Maurizio, Blasio, Giuseppe De, Accetta, Riccardo, Perazzo, Paolo, Stella, Daniele, Bonadies, Marika, Colombo, Chiara, Fozzato, Stefania, Pino, Fabio, Morelli, Ilaria, Colnaghi, Eleonora, Salini, Vincenzo, Denaro, Giuseppe, Beretta, Luigi, Placella, Giacomo, Giardina, Giuseppe, Binda, Mirko, Marcato, Anna, Guzzetti, Luca, Piccirillo, Fabio, Cecconi, Maurizio, Khor, H.M., Lai, Hou Yee, Kumar, C.S., Chee, K.H., Loh, P.S., Tan, Kit Mun, Singh, Simmrat, Foo, Li Lian, Prakasam, Komella, Chaw, Sook Hui, Lee, Meng-Li, Ngim, Joanne H.L., Boon, Huck Wee, Chin, Im Im, Kleinlugtenbelt, Ydo V., Landman, Ellie B.M., Flikweert, Elvira R., Roerdink, Herbert W., Brokelman, Roy B.G., Elskamp-Meijerman, Hannie F., Horst, Maarten R., Cobben, Jan-Hein M.G., Umer, Masood, Begum, Dilshad, Anjum, Anila, Hashmi, Pervaiz M., Ahmed, Tashfeen, Rashid, Haroon U., Khattak, Mujahid J., Rashid, Rizwan H., Lakdawala, Riaz H., Noordin, Shahryar, Juman, Naveed M., Khan, Robyna I., Riaz, Muhammad M., Bokhari, Syedah S., Almas, Ayesha, Wahab, Hussain, Ali, Arif, Khan, Hammad N., Khan, Eraj K., Nur, Aamer Nabi, Janjua, Kholood A., Orakzai, Sajjad H., Khan, Abdus S., Mustafa, Khawaja J., Sohail, Mian A., Umar, Muhammad, Khan, Siddra A., Ashraf, Muhammad, Khan, Muhammad K., Shiraz, Muhammad, Furgan, Ahmad, Ślęczka, Paweł, Dąbek, Piotr, Kumoń, Adam, Satora, Wojciech, Ambroży, Wojciech, Święch, Mariusz, Rycombel, Jacek, Grzelak, Adrian, Nowak- Kózka, Ilona, Gucwa, Jaroslaw, Machala, Waldemar, Ramokgopa, Mmampapatla T., Firth, Gregory B., Karera, Mwalimu, Fourtounas, Maria, Singh, Virsen, Biscardi, Anna, Iqbal, Muhammad N., Campbell, Ryan J., Maluleke, Matimba L., Moller, Carien, Nhlapo, Lerato, Maqungo, Sithombo, Flint, Margot, Nejthardt, Marcin B., Chetty, Sean, Naidoo, Rubendren, Guerra-Farfan, Ernesto, Tomas-Hernandez, Jordi, Garcia-Sanchez, Yaiza, Clua, Miriam Garrido, Molero-Garcia, Vicente, Minguell-Monyart, Joan, Teixidor-Serra, Jordi, Villar-Casares, Maria del Mar, Marsa, Jordi Selga, Porcel-Vazquez, Juan A., Andres-Peiro, Jose-Vicente, Aguilar, Marc, Mestre-Torres, Jaume, Colomina, Maria J., Guilabert, Patricia, Gozalo, M Luisa Paños, Abarca, Luis, Martin, Nuria, Usua, Gemma, Martinez-Ripol, Pedro, Posada, M.A. Gonzalez, Lalueza-Broto, Pilar, Sanchez-Raya, Judith, Camarena, Jorge Nuñez, Fraguas-Castany, Antoni, Balaguer-Castro, Mariano, Torner, Pere, Jornet-Gibert, Montsant, Serrano-Sanz, Jorge, Cámara-Cabrera, Jaume, Salomó-Domènech, Mònica, Yela-Verdú, Christian, Peig-Font, Anna, Ricol, Laura, Carreras-Castañer, Anna, Martínez-Sañudo, Luis, Herranz, Susana, Feijoo-Massó, Carlos, Sianes-Gallén, Mònica, Castillόn, Pablo, Bernaus, Martí, Quintas, Saioa, Gόmez, Olga, Salvador, Jordi, Abarca, Javier, Estrada, Cristina, Novellas, Marga, Torra, Mercè, Dealbert, Alfred, Macho, Oscar, Ivanov, Alexia, Valldosera, Esther, Arroyo, Marta, Pey, Borja, Yuste, Antoni, Mateo, Llorenç, Caso, Julio De, Anaya, Rafael, Higa-Sansone, J.L., Millan, Angelica, Baños, Victoria, Herrera-Mateo, Sergio, Aguado, Hector, Martinez-Municio, Gonzalo, León, Ricardo, Santiago-Maniega, Silvia, Zabalza, Ana, Labrador, Gregorio, Guerado, Enrique, Ramirez-Roldan, Alicia, Cruz, Encarnacion, Cano, Juan R, Bogallo, Jose M, Sangasoongsong, Paphon, Kulachote, Noratep, Sirisreetreerux, Norachart, Pengrung, Nachapan, Chalacheewa, Theerawat, Arnuntasupakul, Vanlapa, Yingchoncharoen, Teerapat, Naratreekoon, Bundit, Kadry, Miriam A, Thayaparan, Surendini, Abdlaziz, Ihab, Aframian, Arash, Imbuldeniya, Arjuna, Movahedi, Roya, Omran, Sherif, Vizcaychipi, Marcela P, Correia, Patricia, Patil, Shashank, Haire, Kevin, Mayor, Amy S.E., Dillingham, Sally, Nicholson, Laura, Elnaggar, Mohamed, John, Joby, Nanjayan, Shashi K, Parker, Martyn J, O'Sullivan, Susan, Marmor, Meir T, Matityahu, Amir, McClellan, Robert T, Comstock, Curt, Ding, Anthony, Toogood, Paul, Slobogean, Gerard, Joseph, Katherine, O'Toole, Robert, Sciadini, Marcus, Ryan, Scott P, Clark, Molly E, Cassidy, Charles, Balonov, Konstantin, Bergese, Sergio D, Phieffer, Laura S, Gonzalez-Zacarias, Alicia A, Marcantonio, Andrew J, Borges, Flavia K., Bhandari, Mohit, Nuñez, Jorge H., Castillon, Pablo, De Caso Rodriguez, Julio, Aguado, Hector J., Popova, Ekaterine, Tonelli, Ana Claudia, Balasubramanian, Kumar, Vincent, Jessica, Harvey, Valerie, Kocaqi, Etri, and Devereaux, P.J.

Published
2024
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18. Association between socioeconomic deprivation and surgical complications in adults undergoing ankle fracture fixation: a population-based analysis

Author

Wolfstadt, Jesse Isaac, Pincus, Daniel, Kreder, Hans J., and Wasserstein, David

Subjects
Ankle injuries -- Statistics -- Care and treatment -- Demographic aspects, Internal fixation -- Statistics -- Complications and side effects -- Demographic aspects, Postoperative complications -- Statistics -- Risk factors -- Demographic aspects, Disadvantaged persons -- Statistics -- Health aspects, Health care disparities -- Statistics, Health, Health care industry
Abstract

Background: Few studies have investigated the outcomes of surgical fracture care among socially deprived patients despite the increased incidence of fractures and the inequality of care received in this group. We evaluated whether socioeconomic deprivation affected the complications and subsequent management of marginalized/homeless patients following surgery for ankle fracture. Methods: In this retrospective, population-based cohort study involving 202 hospitals in Ontario, Canada, we evaluated 45 444 patients who underwent open reduction and internal fixation (ORIF) for ankle fracture performed by 710 different surgeons between Jan. 1, 1994, and Dec. 31, 2011. Multivariable logistic regression models were used to assess the association between deprivation and shorter-term outcomes within 1 year (implant removal, repeat ORIF, irrigation and debridement owing to infection, and amputation). Multivariable Cox proportional hazards models were used to assess longer-term outcomes up to 20 years (ankle fusion and ankle arthroplasty). Results: A higher level of deprivation was associated with an increased risk of irrigation and debridement (quintile 5 v. quintile 1: odds ratio [OR] 2.14, 95% confidence interval [CI] 1.25-3.67, p = 0.0054) and amputation (quintile 4 v. quintile 1: OR 3.56, 95% CI 1.01-12.4, p = 0.0466). It was more common for less deprived patients to have their hardware removed (quintile 5 v. quintile 1: OR 0.822, 95% CI 0.76-0.888, p < 0.0001). There was no correlation between marginalization and subsequent revision ORIF, ankle fusion, or ankle arthroplasty. Conclusion: Marginalized patients are at a significantly increased risk of infection and amputation following surgical treatment of ankle fractures. However, these complications are still extremely uncommon among this group. Socioeconomic deprivation should not prohibit marginalized patients from receiving surgery for unstable ankle fractures. Contexte : Malgre l'incidence accrue des fractures et les inegalites dans la prestation des soins chez les patients au statut socio-economique precaire, peu d'etudes se sont penchees sur les resultats de la chirurgie pour fracture chez cette population. Nous avons voulu verifier si une situation socio-economique precaire influait sur les complications et la prise en charge subsequente des patients marginalises/itinerants apres une chirurgie pour fracture de la cheville. Methodes : Au cours de cette etude de cohorte retrospective basee dans la population regroupant 202 h[delta]pitaux en Ontario, au Canada, nous avons evalue 45 444 patients ayant subi une reduction ouverte avec fixation interne (ROFI) pour fracture de la cheville, effectuee par 710 chirurgiens differents entre le [1.sup.er] janvier 1994 et le 31 decembre 2011. Des modeles de regression logistique multivariee ont servi a evaluer le lien entre le statut precaire et les resultats a court terme (au cours de l'annee) (retrait de l'implant, reintervention pour ROFI, irrigation et debridement en raison d'une infection, et amputation). Des modeles d'analyse multivariee a risques proportionnels de Cox ont servi a evaluer les resultats a plus long terme, jusqu'a 20 ans (fusion de la cheville et arthroplastie de la cheville). Resultats : Le risque d'irrigation et debridement (quintile 5 c. quintile 1 : rapport des cotes [RC] 2,14, intervalle de confiance [IC] de 95 % 1,25-3,67, p = 0,0054) et d'amputation (quintile 4 c. quintile 1 : RC 3,56, IC de 95 % 1,01-12,4, p = 0,0466) etait proportionnel a la precarite de la situation des individus. Les patients moins defavorises etaient moins susceptibles de se faire retirer leurs implants (quintile 5 c. quintile 1 : RC 0,822, IC de 95 % 0,76-0,888,p < 0,0001). On n'a observe aucune correlation entre la marginalisation et une reintervention pour ROFI, fusion de la cheville ou arthroplastie de la cheville. Conclusion : Les patients marginalises sont exposes a un risque significativement plus eleve d'infection et d'amputation apres un traitement chirurgical pour fracture de la cheville. Cependant, de telles complications demeurent extremement rares chez cette population. Un statut socioeconomique precaire ne devrait pas empecher les patients marginalises de recevoir une chirurgie lors de fractures instables de la cheville., Socially deprived patients face important barriers that reduce their access to care, presenting unique challenges for orthopedic surgeons. (1) These patients experience unique health conditions, and disease severity is high [...]

Published
2019
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32. Reporting and evaluating wait times for urgent surgery for hip fracture in Ontario, Canada

Author

Pincus, Daniel, Wasserstein, David, Ravi, Bheeshma, Byrne, James P., Huang, Anjie, Paterson, J. Michael, Nathens, Avery B., Kreder, Hans J., Jenkinson, Richard, and Wodchis, Walter P.

Subjects
Hip fracture repair -- Statistics, Hospital waiting lists -- Evaluation, Health
Abstract

BACKGROUND: Although a delay of 24 hours for hip fracture repair is associated with medical complications and costs, it is unknown how long patients wait for surgery for hip fracture. We describe novel methods for measuring exact urgent and emergent surgical wait times (in hours) and the factors that influence them. METHODS: Adults aged 45 years and older who underwent surgery for hip fracture (the most common urgently performed procedure) in Ontario, Canada, between 2009 and 2014 were eligible. Validated data from linked health administrative databases were used. The primary outcome was the time elapsed from hospital arrival recorded in the National Ambulatory Care Reporting System until the time of surgery recorded in the Discharge Abstract Database (in hours). The influence of patient, physician and hospital factors on wait times was investigated using 3-level, hierarchical linear regression models. RESULTS: Among 42 230 patients with hip fracture, the mean (SD) wait time for surgery was 38.76 (28.84) hours, and 14174 (33.5%) patients underwent surgery within 24 hours. Variables strongly associated with delay included time for hospital transfer (adjusted increase of 26.23 h, 95% CI 25.38 to 27.01) and time for preoperative echocardiography (adjusted increase of 18.56 h, 95% CI 17.73 to 19.38). More than half of the hospitals (37 of 72, 51.4%), compared with 4.8% of surgeons and 0.2% of anesthesiologists, showed significant differences in the risk-adjusted likelihood of delayed surgery. INTERPRETATION: Exact wait times for urgent and emergent surgery can be measured using Canada's administrative data. Only one-third of patients received surgery within the safe time frame (24 h). Wait times varied according to hospital and physician factors; however, hospital factors had a larger impact., Hip fracture repair that is delayed more than 24 hours after hospital presentation is associated with increased medical complications (1) and health care costs. (2,3) Despite known consequences for delays, [...]

Published
2018
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41. Direct medical costs of motorcycle crashes in Ontario

Author

Pincus, Daniel, Wasserstein, David, Nathens, Avery B., Bai, Yu Qing, Redelmeier, Donald A., and Wodchis, Walter P.

Subjects
Ontario. Ministry of Health and Long-Term Care -- Analysis, Medical care, Cost of -- Economic aspects -- Analysis, Motorcycles -- Economic aspects -- Analysis, Health
Abstract

BACKGROUND: There is no reliable estimate of costs incurred by motorcycle crashes. Our objective was to calculate the direct costs of all publicly funded medical care provided to individuals after motorcycle crashes compared with automobile crashes. METHODS: We conducted a population-based, matched cohort study of adults in Ontario who presented to hospital because of a motorcycle or automobile crash from 2007 through 2013. For each case, we identified 1 control absent a motor vehicle crash during the study period. Direct costs for each case and control were estimated in 2013 Canadian dollars from the payer perspective using methodology that links health care use to individuals over time. We calculated costs attributable to motorcycle and automobile crashes within 2 years using a difference-in-differences approach. RESULTS: We identified 26831 patients injured in motorcycle crashes and 281826 injured in automobile crashes. Mean costs attributable to motorcycle and automobile crashes were $5825 and $2995, respectively (p < 0.001). The rate of injury was triple for motorcycle crashes compared with automobile crashes (2194 injured annually/100 000 registered motorcycles v. 718 injured annually/100 000 registered automobiles; incidence rate ratio [IRR] 3.1, 95% confidence interval [CI] 2.8 to 3.3, p < 0.001). Severe injuries, defined as those with an Abbreviated Injury Scale > 3, were 10 times greater (125 severe injuries annually/100 000 registered motorcycles v. 12 severe injuries annually/100000 registered automobiles; IRR 10.4, 95% CI 8.3 to 13.1, p < 0.001). INTERPRETATION: Considering both the attributable cost and higher rate of injury, we found that each registered motorcycle in Ontario costs the public health care system 6 times the amount of each registered automobile. Medical costs may provide an additional incentive to improve motorcycle safety., Motor vehicle safety has improved substantially over the past 100 years. (1) Between 2000 and 2010, for example, deaths related to motor vehicle crashes decreased by 55.1% in 19 developed [...]

Published
2017
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46. Does the Chronicity of Anterior Cruciate Ligament Ruptures Influence Patient-Reported Outcomes Before Surgery?

Author

Nguyen, Joseph T., Wasserstein, David, Reinke, Emily K., Spindler, Kurt P., Mehta, Nabil, Doyle, John B., Marx, Robert G., Amendola, Annunziato, Andrish, Jack T., Brophy, Robert H., Dunn, Warren R., Huston, Laura J., Kaeding, Christopher C., McCarty, Eric C., Parker, Richard D., Wolcott, Michelle L., Wolf, Brian R., and Wright, Rick W.

Published
2017
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47. Biomechanical comparison of 3 medial patellofemoral complex reconstruction techniques shows medial over- constraint but no significant difference in lateralization and contact pressure.

Author

Dahm, Falko, Syed, Hassan, Tomescu, Sebastian, Lin, Heng An, Haimovich, Yaron, Chandrashekar, Naveen, Whyne, Cari, and Wasserstein, David

Abstract

Purpose: The purpose of this study was to investigate biomechanical differences of medial patellofemoral ligament (MPFL) reconstruction, medial quadriceps tendon femoral ligament (MQTFL) reconstruction and a combination of these techniques to restore lateral patellar constraint and contact pressures.Methods: Eight fresh frozen cadaver knees were mounted to a custom jig with physiologic quadriceps tendon loading. Flexion angles and contact pressure (CP) were dynamically measured using Tekscan® pressure sensors and Polhemus® Liberty 6 degree of freedom (6DOF) positioning sensors in the following conditions: 1. Intact 2. MPFL and MQTFL deficient 3. MPFL reconstructed 4. Combined MPFL + MQTFL reconstructed 5. MQTFL reconstructed Lateral patellar translation was tested using horizontally directed 30N force applied at 30° of knee flexion. The knees were flexed in dynamic fashion and CP values were recorded for 10°, 20°, 30°, 50°, 70°, and 90° degrees of flexion. Group differences were assessed with ANOVA's followed by pairwise comparisons with Bonferroni correction.Results: MPFL (p=0.002) and combined MPFL/MQTFL (p=0.034) reconstruction significantly reduced patellar lateralization from +19.28% (9.78%, 28.78%) in the deficient condition to -17.57% (-27.84%, -7.29%) and -15.56% (-33.61%, 2.30%) respectively. MPFL reconstruction was most restrictive and MQTFL reconstruction the least -7.29% (-22.01%, 7.45%). No significant differences were found between the three reconstruction techniques. Differences in CP between the three reconstruction techniques were not significant (<0.02 MPa) at all flexion angles.Conclusion: The present study found no significant difference for patellar lateralization and patellofemoral CP between MPFL, combined MPFL/MQTFL and MQTFL reconstruction. All 3 techniques resulted in stronger lateral patellar constraint compared to the native state while the MQTFL reconstruction emulated the intact state the closest.Clinical Relevance: Various surgical techniques for medial patellofemoral complex reconstruction can restore patellar stability with similar patellofemoral articular pressures. [ABSTRACT FROM AUTHOR]

Published
2023
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