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Background A recently proposed risk factor for periprosthetic joint infections (PJI) in men is benign prostatic hyperplasia (BPH). The objective was to explore the association of BPH on 1) 90-day complications, 2) length of stay (LOS), 3) readmission rates, and 4) healthcare expenditures following total shoulder arthroplasty (TSA). Methods A retrospective query was performed using a nationwide claims database from January 2005 to March 2014 for male patients undergoing primary TSA. The study cohort included 5067 patients with BPH while 50,720 patients served as the comparison cohort. Logistic regression determined the association of BPH on complications and readmissions. A p value less than 0.001 was significant. Results Patients with BPH had higher incidence and odds (36.8 vs. 6.2%; OR: 2.73, p Conclusions BPH is associated with increased complications and healthcare expenditures following total shoulder arthroplasty. The investigation can be used to educate BPH patients of the possible adverse events which may occur within ninety-days following primary TSA for the treatment of glenohumeral osteoarthritis.

Background: Anemia is a modifiable risk factor that may influence postoperative complications following orthopedic surgical procedures. The objective was to determine the influence of preoperative anemia severity on postoperative complications and length of stay (LOS) following total elbow arthroplasty (TEA). Methods: The American College of Surgeons National Surgical Quality Improvement Program registry was queried from 2006 to 2019 for patients undergoing primary TEA. Using the World Health Organization definitions of anemia, patients undergoing TEA were stratified into 3 cohorts: nonanemia (hematocrit >36% for women, >39% for men), mild anemia (hematocrit 33%-36% for women, 33%-39% for men), and moderate-to-severe anemia (hematocrit Results: After exclusion, 589 patients, of whom 369 (62.6%) did not have anemia, 129 (21.9%) had mild anemia, and 91 (15.5%) had moderate/severe anemia, were included. Increasing severity of anemia was associated with an increased average hospital LOS (2.30 vs 2.81 vs 4.91 days, P < .001). There was a statistically significant increase in blood transfusions (1.08% vs 7.75% vs 17.58%, P < .001), major complications (9.21% vs 17.83% vs 34.07%, P < .001), any complications (11.11% vs 23.26% vs 36.26%, P < .001), and extended LOS ≥6 days (6.23% vs 6.98% vs 31.87%, P < .001) with increasing severity of anemia. Multivariate analysis identified moderate-to-severe anemia was significantly associated with major complications and extended LOS ( P < .001). Conclusions: Preoperative anemia is a modifiable risk factor for medical and surgical complications within 30 days of TEA.

Study Design: Retrospective study. Objective: To determine whether opioid use disorder (OUD) patients undergoing 1- to 2-level anterior cervical discectomy and fusion (1-2ACDF) have higher rates of: 1) in-hospital lengths of stay (LOS); 2) readmissions; 3) complications; and 4) costs. Methods: OUD patients undergoing primary 1-2ACDF were identified within the Medicare database and matched to a control cohort in a 1:5 ratio by age, sex, and medical comorbidities. The query yielded 80,683 patients who underwent 1-2 ACDF with (n = 13,448) and without (n = 67,235) OUD. Outcomes analyzed included in-hospital LOS, 90-day readmission rates, 90-day medical complications, and costs. Multivariate logistic regression analyses were used to calculate odds-ratios (OR) for medical complications and readmissions. Welch’s t-test was used to test for significance for LOS and cost between the cohorts. An alpha value less than 0.002 was considered statistically significant. Results: OUD patients were found to have significantly longer in-hospital LOS compared to their counterparts (3.41 vs. 2.23-days, P < .0001), in addition to higher frequency and odds of requiring readmissions (21.62 vs. 11.57%; OR: 1.38, P < .0001). Study group patients were found to have higher frequency and odds of developing medical complications (0.88 vs. 0.19%, OR: 2.80, P < .0001) and incurred higher episode of care costs ($20,399.62 vs. $16,812.14, P < .0001). Conclusion: The study can help to push orthopaedic surgeons in better managing OUD patients pre-operatively in terms of safe discontinuation and education of opioid drugs and their effects on complications, leading to more satisfactory outcomes.

Background Paroxetine (Paxil) is a selective serotonin reuptake inhibitor (SSRI), FDA approved for the treatment of panic disorder, depression, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder, OCD, and premenstrual dysphoric disorder. Its efficacy is linked to potentiation of serotoninergic activity in the central nervous system resulting from inhibition of neuronal reuptake of serotonin (5-hydroxytryptamine, 5-HT). A dreaded iatrogenic complication of administering Paxil and other SSRIs is the serotonin syndrome. It has normally been reported to have occurred with concomitant administration of MAOIs and SSRIs or in significant overdose of SSRI. It has rarely been reported with therapeutic doses of paroxetine. Only one other case was found in our research. Case Report We present a case of an 80-year-old Russian female who presented with altered mental status, myoclonus, and rhabdomyolysis. Her medical history was significant for major depression treated with paroxetine for thr last 6 months. After ruling out infectious, metabolic, cerebrovascular, and cardiac causes for her change in mentation, we diagnosed her with serotonin syndrome due to the administration of paroxetine, albeit at therapeutic doses. After immediately discontinuing the offending drug, the patient was aggressively hydrated with fluids and treated with an antiserotoninergic agent, cyprohepatidine. She responded to the cyproheptadine and fully recovered by day 3 of admission. Discussion The serotonin syndrome is an iatrogenic complication of proserotoninergic drugs comprising of at least three signs and symptoms reflecting mental status changes, autonomic instability, and neuromuscular abnormalities. As the exposure to proserotoninergic drugs is increasing, so is the incidence of the serotonin syndrome. Our research shows that the syndrome has mainly occurred in conjunction with overdoses, drug interactions such as concomintant use of MAOIs or neuroleptics, and in pediatric populations. However, we report a case where the syndrome occurred in a patient who was taking paroxetine routinely at therapeutic doses. Conclusion It is important to suspect this potentially lethal and possibly reversible cause in any patient that presents acutely with mental status changes and is known to be on proserotoninergic drugs regardless of duration and dosage. Early suspicion would help the patient9s prognosis while also preempting numerous diagnostic tests and possibly harmful treatments. Although the reported incidence of serotonin syndrome is 0.4/1,000, its actual incidence might be underestimated due to lack of clinical suspicion and diagnosis.

Prostate cancer represents a major health problem worldwide. The aim of this study is to determine if the rate of disease screening plays a major role in prostate cancer development in different ethnic groups. Other factors, including PSA levels, smoking, and size of the prostate glands and different pathological diagnosis are also evaluated in this study. Method A retrospective study involving 190 patients, who showed either prostate-related symptoms or enlarged prostate glands in routine digital rectal examination (DRE), prostate-specific antigen (PSA) and prostate sonograms were done to evaluate for the size of the gland. Patients with the PSA levels > 4 ng/mL got transrectal prostate biopsy. The age of diagnosis, race, PSA level, and gland size were compared among patients with adenocarcinoma, benign adenomatous hyperplasia (BPH) and chronic prostatitis. Results In our study there were 35.4% Afro-Americans, 30% whites, and 17.4% Hispanics and Asians each. The mean age of diagnosing patients with prostate cancer was 65.7 years; for BPH and chronic prostatitis it was 64.4 years. Though the whites were diagnosed to have prostate carcinoma 5 years earlier than the Asians and Hispanics and 7 years earlier than the Afro-Americans, there was no statistical significance between the ethnic groups. Comparisons of the PSA levels with the overall size of the prostate gland (p = .0519), age (p = .6182), smoking (p = .025), and the duration of smoking (p = .1292) failed to show any statistical significance. There was a strong positive correlation between disease occurrence and PSA level. Only 11% of the healthy individuals had PSA level of > 10 ng/mL, 36% of patients with BPH, 38% with chronic prostatitis, and 60% of patients with adenocarcinoma (p Conclusion We did not find any delay in screening among the ethnic groups, probably due to an increase in awareness of the mortality due to prostate cancer. The incidence of different pathological diagnosis also did not differ among the ethnic groups. Though PSA levels did not correlate with the age, size of the gland, or the smoking, there was a good correlation with patients with adenocarcinoma as compared to patients with BPH or chronic prostatitis.