To determine the effect of anti-factor Xa assay dosing of low-molecular-weight heparin (LMWH) on rates of venous thromboembolism (VTE), deep vein thrombosis (DVT), pulmonary embolism (PE), bleeding, and mortality among orthopaedic trauma patients.PubMed/MEDLINE, Embase, Ovid, Cochrane Central Register of Controlled Trials (CENTRAL), clinicaltrials.gov , and Scopus were systematically searched from inception of the database to 2021.Prospective, retrospective, and randomized controlled trial studies were included if they compared rates of VTE, DVT, PE, bleeding, and/or mortality between orthopaedic trauma patients receiving anti-factor Xa-based LMWH dosing and those receiving standard dosing.Two independent reviewers screened titles and abstracts for eligibility. Study characteristics including study design, inclusion criteria, and intervention were extracted.Meta-analysis was performed using pooled proportion of events (effect size) with 95% confidence intervals. A random-effects model was used. Heterogeneity was quantified by Higgins I 2 . Heterogeneity and variability between subgroups indicated differences in the pooled estimate represented by a P -value.Six hundred eighty-five studies were identified, and 10 studies including 2870 patients were included. In total, 30.3% and 69.7% received an adjusted and nonadjusted dose of LMWH, respectively. The rate of VTE and DVT were significantly lower in the anti-factor Xa-adjusted cohort, whereas there was no statistically significant difference in rates of PE, bleeding, or mortality between the cohorts.This systematic review and meta-analysis demonstrates that anti-factor Xa activity assay dosing of LMWH among orthopaedic trauma patients leads to a reduction in overall DVT rates, although not PE rates, without an increased risk of bleeding events.Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
BACKGROUND Early year-round training in a single sport has been associated with high rates of overuse injuries. Despite this increasingly well-known risk of early sport specialization, many young athletes elect to specialize in a single sport due to the perception that this practice gives them the best chance of attaining elite athletic status. However, early specialization in women's ice hockey has not previously been shown to be reliably associated with attainment of elite levels of performance. We hypothesized that professional women's ice hockey players specialize in mid-adolescence, at an age comparable to their male counterparts. METHODS An anonymous survey was given to members of two National Women's Hockey League teams. The athletes were asked how many years they have been playing hockey, at what age they began playing only hockey on a year-round basis, how many sports they played in addition to hockey, and if they felt that playing multiple sports while growing up positively affected their hockey careers. RESULTS Fifty-four players completed the survey. The players reported playing hockey for an average of 19.4 ± 3.4 years. They began specializing in ice hockey at an average of 16.1 ± 3.3 years of age, 2 years later than previously reported in male NHL and NCAA athletes. Before specializing in hockey, players played an average of 3.5 ± 1.4 other sports. Ninetyone percent of players reported feeling as though playing other sports positively affected their hockey career.
While prolonged operative time and increased levels fused have been shown to increase the risk of prolonged intensive care unit (ICU) length-of-stay (LOS), studies are limited in guiding decision-making regarding the need for intensive care postoperatively. This is especially the case among the cohort of adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF); associations between comorbidities and ICU LOS are not well-delineated. AIS patients who underwent PSF from January 1st, 2016 to December 1st, 2016 at 101 participating centers were identified using the American College of Surgeons (ACS) National Surgical Quality Im-provement Project (NSQIP) Pediatric database. Patients were subsequently grouped by ICU LOS 0-1 day; 2-3 days; and >3 days. Multivariate regression identified predictors of increased ICU LOS. 2,346 AIS patients were included. The >3 days and 2-3 days groups had higher asthma rates compared to 0-1 day. The >3 days group had higher rates of structural airway abnormalities and he-matologic disorders. Cognitive impairment rates were highest for >3-day ICU LOS. Hematologic dis-orders, structural airway abnormalities, asthma and cognitive impairment were associated with prolonged ICU LOS. These results help inform targets for optimization of acute short-term postoperative care as well as assisting in risk stratification to improve outcomes and reduce costs for ICU-level care of AIS patients at ACS NSQIP Pediatric program-participating hospitals. Level of Evidence: III.
We sought to conduct a systematic review of the literature and a meta-analysis of post-operative outcomes following TKA with an all-polyethylene tibial (APT) or a metal-backed tibial component (MBT). A systematic review of the literature was conducted to identify all studies comparing APT and MBT for TKA based upon rates of complications, revisions, reoperation, and patient-reported outcomes. Data was pooled and relative risk of each outcome measure at short (< 5 year), mid (5-10 year), and long (> 10 year) follow-up was calculated. Thirty-eight studies met criteria and were included for analysis, totaling 113,413 primary TKAs performed in 106,490 patients. Of these, 21,752 were performed with an APT and 91,661 with an MBT. APT had a statistically significant decrease in the relative risk of revisions, reoperations, total complications, septic complications, and aseptic complications at one-to-five-year follow-up. There was no statistically significant difference in the relative risk of these metrics between APT and MBT beyond 5 years. This study demonstrates that patients with APT components, compared to the MBT tibial components, had significantly lower rates of complications and revisions at 1-to-5-year follow-up, and no difference in these metrics beyond five years. Further prospective studies are warranted for better external validity of results found in this study.
Prematurity is associated with surgical complications. This study sought to determine the risk of prematurity on 30-day complications, reoperations, and readmissions following ≥7-level PSF for AIS which has not been established. Utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP)-Pediatric dataset, all AIS patients undergoing ≥7-level PSF from 2012-2016 were identified. Cases were 1:1 propensity score-matched to controls by age, sex, and number of spinal levels fused. Prematurity sub-classifications were also evaluated: extremely (<28 weeks), very (28-31 weeks), and moderate-to-late (32-36 weeks) premature. Univariate analysis with post hoc Bonferroni compared demographics, hospital parameters, and 30-day outcomes. Multivariate logistic regression identified independent predictors of adverse 30-day outcomes. 5531 patients (term = 5099; moderate-to-late premature = 250; very premature = 101; extremely premature = 81) were included. Premature patients had higher baseline rates of multiple individual comorbidities, longer mean length of stay, and higher 30-day readmissions and infections than the term cohort. Thirty-day readmissions increased with increasing prematurity. Very premature birth predicted UTIs, superficial SSI/wound dehiscence, and any infection, and moderate-to-late premature birth predicted renal insufficiency, deep space infections, and any infection. Prematurity of AIS patients differentially impacted rates of 30-day adverse outcomes following ≥7-level PSF. These results can guide preoperative optimization and postoperative expectations.
