Search

Introduction: Sleep Apnea (SA) is a common sleep disorder that increases postoperative morbidity. There is limited research on how SA influences outcomes following operative fixation of ankle fractures. Therefore, the aim of this study was to determine whether patients who undergo surgical fixation for bimalleolar ankle fractures have higher rates of medical complications and health care expenditures. Methods: A retrospective review from January 1, 2005 to March 31, 2014 was conducted using the parts A and B Medicare Data from PearlDiver database. Patients with and without SA on the day of the primary open reduction and internal fixation (ORIF) of their bimalleolar ankle fractures were queried using the International Classification of Diseases, Ninth Revision codes. Welch's t -tests were used to compare costs of care. A multivariate binomial logistic regression model was used to calculate the odds ratio (OR) of adverse events. A P-value <.001 was considered statistically significant. Results: There were 20 560 patients (SA = 3150; comparison cohort = 17 410) who underwent ORIF for bimalleolar ankle fractures during the study period. Sleep apnea patients were found to have significantly higher rates and odds of 90-day medical complications (21.42% vs 7.47%, OR: 3.11, P <.0001) and 90-day costs of care ($7213.12 vs $5415.79, P <.0001). Conclusion: This research demonstrates an increased risk of postoperative medical complications and health care costs among patients with SA undergoing ORIF for bimalleolar ankle fractures. Level of Evidence: Therapeutic, Level IV: Retrospective [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort study. Objectives: As of 2022, the Centers for Medicare and Medicaid Services does not provide nationwide coverage for cervical disc arthroplasty (CDA). The aim was to determine whether Medicare beneficiaries have differences in: (1) lengths of stay (LOS); (2) complications; (3) readmissions; and (4) costs of care. Methods: Using the 2010 to 2020 PearlDiver database, we queried patients undergoing primary CDA for degenerative disc pathology. Study groups patients were those undergoing CDA with Medicare coverage (n = 1467); patients without Medicare coverage were the comparison cohort (n = 15,389). Endpoints were to compare demographics and comorbidities within the Elixhauser comorbidity index (ECI), LOS, 90-day complications, 90-day readmissions, and 90-day reimbursements. A multivariate logistic regression was used to calculate odds (OR) of medical complications and readmissions within 90-days. A P -value less than.003 was significant. Results: Patients with Medicare coverage undergoing CDA had higher mean ECI compared to alternative payers (5.24 vs 3.26; P <.0001). Mean LOS was significantly higher for Medicare beneficiaries (2.20 vs 1.76 days; P <.010). There was no significant differences in odds of all medical complications (OR: 1.19, 95% CI:.98-1.44; P =.069) or readmission rates (1.77% vs 1.33%, OR:0.82, 95% CI:.50-1.29; P =.417) within 90-days following the index procedure among Medicare beneficiaries vs alternative payers. Non-Medicare beneficiaries had higher 90-day reimbursements compared to Medicare beneficiaries ($6,700 vs $7,086, P <.001). Conclusions: Medicare beneficiaries despite having slightly longer lengths of stay did not have higher rates of medical complications or readmissions. Surgeons and policy makers may use this data to consider alternative treatments in Medicare patients. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]