Ali Aneizi

University of Maryland, Baltimore

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R. Frank Henn

University of Maryland, Baltimore

Patrick M.J. Sajak

University of Maryland, Baltimore

Jonathan D. Packer

University of Maryland, Baltimore

Tina Zhang

University of Maryland, Baltimore

Sean J. Meredith

University of Maryland, Baltimore

Dominic J. Ventimiglia

University of Maryland, Baltimore

Matheus B. Schneider

University of Maryland, Baltimore

Cameran I. Burt

University of Maryland, Baltimore

Tristan B. Weir

Thomas Jefferson University Hospital

Mohit N. Gilotra

University of Maryland, Baltimore

Cooperative Institutions

University of Maryland, Baltimore

University of Maryland Medical Center

University of Pittsburgh

National Institutes of Health

University of Pittsburgh Medical Center

University of Maryland Rehabilitation & Orthopaedic Institute

University of Maryland, College Park

National Heart Lung and Blood Institute

UPMC Health System

University of Maryland Medical System

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Preoperative Expectations in Hand Surgery Patients

Journal of Hand and Microsurgery (2022)

Patrick M.J. Sajak Samir Kaveeshwar Ali Aneizi Alexander Hahn Cameran I. Burt

Studies have shown a link between patients' preoperative expectations and their postoperative satisfaction. However, limited studies exist concerning patient factors associated with higher preoperative expectations in the hand surgery population. This study analyzed preoperative expectation scores of patients undergoing hand surgery and aimed to determine associated patient characteristics.

Hand surgery

10.1055/s-0042-1748782

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Citations (1)

Factors Influencing Press Ganey Ambulatory Surgery Scores in Patients Undergoing Upper Extremity Procedures

JAAOS Global Research and Reviews (2021)

Tristan B. Weir Tina Zhang Julio J. Jauregui Ali Aneizi Patrick M.J. Sajak

Introduction: We sought to determine whether patient and surgical factors are associated with the Press Ganey Ambulatory Surgery Survey (PGAS) satisfaction scores in patients undergoing outpatient upper extremity procedures. Methods: A retrospective review of a single academic urban hospital's Press Ganey database was performed for patients undergoing upper extremity procedures. PGAS scores above an a priori threshold were considered satisfied. Logistic regression analyses for the PGAS Total and Provider Scores were performed to determine the predictors of patient satisfaction. Results: Of the 198 patients included, the mean age was 49.6 ± 17.1 years and 55% were men. For the Total Score, multivariable analysis showed significantly less satisfaction with continuous catheter peripheral brachial plexus nerve blocks (CC-PNBs) (odds ratio [OR], 0.37; P = 0.008) and internet surveys (OR, 0.39; P = 0.007), but smokers had surprisingly more satisfaction (OR, 4.90; P = 0.016). For the Provider Score, a multivariable analysis showed less satisfaction with CC-PNBs (OR, 0.45; P = 0.035), internet surveys (OR, 0.46; P = 0.026), and geographic location (OR, 0.40; P = 0.005). Preoperative Patient-Reported Outcomes Measurement Information System scores were not associated with the PGAS scores. Discussion: Factors influencing satisfaction in patients undergoing upper extremity procedures may be modifiable (CC-PNBs and survey administration method) or nonmodifiable (geographic location) and may influence future reimbursement.

Reimbursement

10.5435/jaaosglobal-d-20-00209

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Press Ganey Surveys in Patients Undergoing Upper-Extremity Surgical Procedures

Journal of Bone and Joint Surgery (2021)

Tristan B. Weir Tina Zhang Julio J. Jauregui Ali Aneizi Matheus B. Schneider

Background: Patient satisfaction surveys are important measures of the patient experience that provide data for quality improvement. The purpose of this study was to establish the response rate and the factors associated with the completion of the Press Ganey (PG) Ambulatory Surgery Survey (PGAS) in patients who underwent ambulatory upper-extremity surgical procedures. Methods: A prospective orthopaedic registry at a single academic ambulatory surgical center was retrospectively reviewed for patients who underwent an upper-extremity surgical procedure from 2015 to 2019. The institutional PG database was queried to determine the patients who completed the PGAS postoperatively. The response rate was calculated, and baseline characteristics and patient-reported outcome measures were compared between responders and nonresponders. Results: Of the 1,489 patients included, 201 (13.5%) were responders and 1,288 (86.5%) were nonresponders. Differences existed in baseline characteristics between groups, with responders being significantly older (p = 0.004) and having significantly higher proportions of White race (p < 0.001), college education (p = 0.011), employment (p = 0.005), marriage (p = 0.006), and higher income earners (p < 0.001). Responders had significantly better baseline Patient-Reported Outcomes Measurement Information System scores across multiple domains (p < 0.05), but these differences were not clinically meaningful. Conclusions: PGAS response rates were low (13.5%), and differences between responders and nonresponders may be utilized by hospitals to target feedback from underrepresented patient populations. Surgeons, policymakers, and health-care administrators should use caution with the interpretation of PGAS results because responders may not be representative of all patients.

Patient Education

10.2106/jbjs.20.01467

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PROMIS physical function two weeks following orthopaedic surgery

Journal of Clinical Orthopaedics and Trauma (2020)

Gregory Perraut Ali Aneizi Vidushan Nadarajah Patrick M.J. Sajak Michael P. Smuda

Depression

Narcotic

10.1016/j.jcot.2020.06.014

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Citations (3)

Perioperative Opioid Use in Anterior Cruciate Ligament Reconstruction Patients

The Journal of Knee Surgery (2021)

Ali Aneizi Elizabeth Friedmann Leah E. Henry Gregory Perraut Patrick M.J. Sajak

Abstract Anterior cruciate ligament reconstruction (ACLR) is one of the most commonly performed outpatient orthopaedic procedures, yet there is little data about perioperative opioid prescribing practices. The purposes of this study were to quantify the perioperative opioid prescriptions filled by patients who underwent ACLR and to identify factors associated with greater postoperative opioid use. Patients who underwent ACLR at a single institution between June 2015 and May 2017 were studied using a regional prescription monitoring database to identify all preoperative and postoperative outpatient opioid prescriptions up to 2 years postoperatively. The number of morphine milligram equivalents of each opioid was calculated to determine total morphine milligram equivalents (TMEs) filled preoperatively, at discharge, and refilled postoperatively. Patients who refilled an opioid prescription postoperatively were compared with those who did not. Ninety-nine of 269 (36.8%) total patients refilled an opioid prescription postoperatively. Thirty-three patients (12.3%) required a refill after 2 weeks postoperatively, and no patients refilled after 21 months postoperatively. Fifty-seven patients (21%) received an opioid prescription in the 2 years following surgery that was unrelated to their ACL reconstruction. Increased age, higher body mass index (BMI), government insurance, current or prior tobacco use history, preoperative opioid use, and greater number of medical comorbidities were significantly associated with refilling a prescription opioid. Higher BMI and government insurance were independent predictors of refilling. Higher preoperative TMEs and surgeon were independent predictor of greater refill TMEs. In the opioid-naïve subgroup of 177 patients, only higher BMI was a predictor of refilling, and only greater comorbidities was a predictor of greater refill TMEs. The results demonstrate that preoperative opioid use was associated with postoperative opioid refills and higher refill TMEs in a dose-dependent fashion. A higher percentage of patients received an opioid prescription for reasons unrelated to the ACL reconstruction than refilled a prescription after the first 2 weeks postoperatively.

10.1055/s-0041-1729620

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Predictors of PROMIS Physical Function at 2 Years following Knee Surgery

The Journal of Knee Surgery (2020)

Darius Hunt Tina Zhang Scott Koenig Ali Aneizi Gregory Perraut

The purpose of this study was to evaluate Patient-Reported Outcomes Measurement Information System physical function (PROMIS PF) 2 years following knee surgery, and identify preoperative factors associated with postoperative PROMIS PF. Three hundred and sixty-five patients, age 17 years and older, undergoing knee surgery at one institution were studied. Patients completed multiple questionnaires prior to surgery and again 2 years postoperatively including PROMIS PF, International Knee Documentation Committee (IKDC), joint and body numeric pain scales (NPS), Tegner's activity scale (TAS), and Marx's activity rating scale (MARS). Mean PROMIS PF improved from 41.4 to 50.9 at 2 years postoperatively (p < 0.001) and was strongly correlated with 2-year IKDC scores. Older age, female gender, non-Hispanic ethnicity, unemployment, lower income, government insurance, smoking, preoperative opioid use, having a legal claim, comorbidities, previous surgeries, higher body mass index (BMI), and knee arthroplasty were associated with worse 2-year PROMIS PF. Multivariable analysis confirmed that lower BMI, less NPS body pain, and higher MARS were independent predictors of greater 2-year PROMIS PF and better improvement in PROMIS PF. In this large, broad cohort of knee surgery patients, multiple preoperative factors were associated with PROMIS PF 2 years postoperatively. PROMIS PF scores improved significantly, but worse 2 year PROMIS PF scores and less improvement from baseline were independently predicted by higher BMI, greater NPS body pain, and lower MARS activity level. PROMIS PF can be implemented as an efficient means to assess outcomes after knee surgery.

Knee surgery

10.1055/s-0040-1716360

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Long-Term Outcomes of Multiligament Knee Injuries

Journal of Orthopaedic Trauma (2022)

Tina Zhang Keyan Shasti Andrew G. Dubina Matheus B. Schneider Ali Aneizi

To characterize long-term outcomes of multiligament knee injuries (MLKIs) using patient-reported outcome measures, physical examination, and knee radiographs.Retrospective clinical follow-up.Twenty knees (18 patients) were evaluated at a mean follow-up of 13.1 years (range 11-15 years). The primary outcome measure was the Internal Knee Documentation Committee score. Patients also completed secondary patient-based outcome assessments including Patient-Reported Outcomes Measurement Information System computer adaptive testing, Short Form-36, and Tegner activity score. Sixteen knees (14 patients) also had physical examination and bilateral knee radiographs assessed with the Kellgren-Lawrence score.The mean Internal Knee Documentation Committee score was 56 points, which was significantly lower than the age-matched normative value of 77 ( P = 0.004) and exceeds the minimum clinically important difference of 12 points. Most secondary outcome scores were worse than normative population values. Posttraumatic arthritis was present in 100% of MLKIs that had radiographs. Comparing operative versus nonoperative management, there were no statistical differences in patient demographics, injury characteristics, physical examination, or imaging, but surgical patients had better Short Form-36 Social Functioning (89 vs. 63, P = 0.02) and Tegner scores (4.5 vs. 2.9, P = 0.05).The long-term outcomes of MLKIs are generally poor, and posttraumatic radiographic evidence of arthritis seems to be universal . Operative management of these injuries may improve long-term outcomes. Clinicians should be aware of these results when counseling patients.Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Knee Dislocation

10.1097/bot.0000000000002348

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Citations (3)

Preoperative expectations and early postoperative met expectations of extremity orthopaedic surgery

Journal of Clinical Orthopaedics and Trauma (2020)

Leah E. Henry Ali Aneizi Vidushan Nadarajah Patrick M.J. Sajak Kali N. Stevens

Demographics

10.1016/j.jcot.2020.06.027

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Citations (17)

PROMIS Depression and Anxiety in shoulder surgery patients

The Bone & Joint Journal (2022)

Mitchell Baker Fernando Albelo Tina Zhang Matheus B. Schneider Michael J. Foster

The purpose of this study was to assess the prevalence of depression and anxiety symptoms in patients undergoing shoulder surgery using the National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) Depression and Anxiety computer adaptive tests, and to determine the factors associated with more severe symptoms. Additionally, we sought to determine whether PROMIS Depression and Anxiety were associated with functional outcomes after shoulder surgery.This was a retrospective analysis of 293 patients from an urban population who underwent elective shoulder surgery from 2015 to 2018. Survey questionnaires included preoperative and two-year postoperative data. Bivariate analysis was used to identify associations and multivariable analysis was used to control for confounding variables.Mean two-year PROMIS Depression and Anxiety scores significantly improved from preoperative scores, with a greater improvement observed in PROMIS Anxiety. Worse PROMIS Depression and Anxiety scores were also significantly correlated with worse PROMIS Physical Function (PF) and American Shoulder and Elbow Surgeons scores (ASES). After controlling for confounding variables, worse PROMIS Depression was an independent predictor of worse PROMIS PF, while worse PROMIS Anxiety was an independent predictor of worse PROMIS PF and ASES scores.Mean two-year PROMIS Depression and Anxiety scores improved after elective shoulder surgery and several patient characteristics were associated with these scores. Worse functional outcomes were associated with worse PROMIS Depression and Anxiety; however, more severe two-year PROMIS Anxiety was the strongest predictor of worse functional outcomes. Cite this article: Bone Joint J 2022;104-B(4):479-485.

Depression

10.1302/0301-620x.104b4.bjj-2021-1089.r1

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Citations (13)

Association Between Extracellular Matrix Expansion Quantified by Cardiovascular Magnetic Resonance and Short-Term Mortality

Circulation (2012)

Timothy C. Wong Kayla Piehler Christopher G Meier Stephen M. Testa Amanda M. Klock

Background— Extracellular matrix expansion may be a fundamental feature of adverse myocardial remodeling, it appears to be treatable, and its measurement may improve risk stratification. Yet, the relationship between mortality and extracellular matrix is not clear because of difficulties with its measurement. To assess its relationship with outcomes, we used novel, validated cardiovascular magnetic resonance techniques to quantify the full spectrum of extracellular matrix expansion not readily detectable by conventional cardiovascular magnetic resonance. Methods and Results— We recruited 793 consecutive patients at the time of cardiovascular magnetic resonance without amyloidosis or hypertrophic cardiomyopathy as well as 9 healthy volunteers (ages 20–50 years). We measured the extracellular volume fraction (ECV) to quantify the extracellular matrix expansion in myocardium without myocardial infarction. ECV uses gadolinium contrast as an extracellular space marker based on T1 measures of blood and myocardium pre— and post–gadolinium contrast and hematocrit measurement. In volunteers, ECV ranged from 21.7% to 26.2%, but in patients it ranged from 21.0% to 45.8%, indicating considerable burden. There were 39 deaths over a median follow-up of 0.8 years (interquartile range 0.5–1.2 years), and 43 individuals who experienced the composite end point of death/cardiac transplant/left ventricular assist device implantation. In Cox regression models, ECV related to all-cause mortality and the composite end point (hazard ratio, 1.55; 95% confidence interval, 1.27–1.88 and hazard ratio, 1.48; 95% confidence interval, 1.23–1.78, respectively, for every 3% increase in ECV), adjusting for age, left ventricular ejection fraction, and myocardial infarction size. Conclusions— ECV measures of extracellular matrix expansion may predict mortality as well as other composite end points (death/cardiac transplant/left ventricular assist device implantation).

Interquartile range

10.1161/circulationaha.111.089409

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Citations (464)