Carmel Medical Center

Parkinson's disease (PD) is an increasingly common comorbidity in patients undergoing total knee arthroplasty (TKA), yet its impact on readmissions remains poorly defined. Using the Nationwide Readmissions Database 2020-2022, we identified elective, primary TKA cases. Patients with oncologic diagnoses, COVID-19-related admissions, acute fractures, and contralateral knee arthroplasty were excluded. Only the first readmission within 90 days was analyzed. Propensity score matching (1:1) was performed for demographics, comorbidities, hospital factors, and primary payer. The primary outcome was 90-day readmission. Secondary outcomes included infection-related readmissions, surgical procedures during readmission, readmission length of stay, readmission costs, and in-hospital mortality. After matching, 7286 patients were included (3675 PD vs 3611 non-PD). PD patients had a significantly higher 90-day readmission rate (13.0% vs 7.3%; P < .01). Infection-related readmissions (4.1% vs 2.2%; P < .01) and surgical procedures during readmission (7.5% vs 4.1%; P < .01) were more frequent in PD patients. Readmission length of stay was longer (5.9 vs 4.1 days; P < .01), and readmission costs were higher ($63,023 vs $48,855; P < .01). In-hospital mortality during readmission was also higher in PD patients (0.3% vs 0.1%; P < .01). PD is associated with a significantly higher risk of 90-day readmission following TKA, with readmissions frequently involving infection-related complications and surgical intervention. These findings highlight the importance of tailored perioperative care and enhanced postdischarge monitoring in this vulnerable population. Level III.

Adherence to antihypertensive medications is essential to ensure therapeutic effectiveness. However, the long-term clinical impact of adherence during the first year of treatment in elderly patients remains uncertain. To evaluate the level of adherence to antihypertensive therapy during the first year following diagnosis in elderly patients and to assess its long-term clinical implications. This retrospective cohort study included adult patients aged ≥ 65 years with newly diagnosed essential hypertension. Medication adherence during the first year after diagnosis was assessed using the proportion of days covered (PDC). Clinical outcomes-including myocardial infarction, stroke, and all-cause mortality-were evaluated beyond the first year, with an average follow-up of 108 months. Data were extracted from the electronic medical records of a large community-based healthcare provider. A total of 2934 patients were included in the analysis. The mean age was 72.4 years, and approximately 60% were women. Among the cohort, 21.3% had a PDC of less than 70%. Adherence above the 70% threshold was significantly associated with a reduced incidence of stroke (HR = 0.59; 95% CI 0.37-0.94; p = 0.028). Higher adherence (≥ 70%) to antihypertensive therapy during the first year of treatment in elderly patients was associated with a significantly lower incidence of stroke in subsequent years. These findings highlight the importance of early adherence and support the need for targeted interventions to promote sustained medication use, even in older populations.

Abstract Background Patients with Parkinson’s disease (PD) undergoing total hip arthroplasty (THA) may be at increased risk for postoperative complications due to neuromuscular dysfunction and medical frailty. Contemporary national data on short-term outcomes following elective primary THA in this population remain limited. This study evaluated index hospitalization complications and 90-day readmission with procedural escalation after elective primary THA in patients with PD. Methods We performed a retrospective cohort study using the Nationwide Readmissions Database (2020–2022). Adult patients undergoing elective primary THA on hospital day 0 were identified. A 1:5 propensity score-matched cohort was constructed using demographics, payer, hospital characteristics, calendar year, and comorbidities (all standardized mean differences &lt; 0.1). Index complications, 90-day readmission, and readmission-associated procedural escalation (any procedure, reoperation, and revision) were assessed. Results The matched cohort included 12,143 elective primary THAs (2,043 PD; 10,100 controls). PD was associated with higher rates of perioperative complications, including blood transfusion, pneumonia, urinary tract infection, and hip dislocation (all p ≤ 0.015), while in-hospital mortality remained low and similar between groups. Within 90 days, PD patients had higher readmission (10.3% vs 5.8%; OR 1.86; p &lt; 0.001) and markedly increased procedural escalation, including reoperation (3.3% vs 0.9%) and revision (3.0% vs 0.7%) (all p &lt; 0.001). Length of stay was longer in PD patients, with no significant difference in hospital charges. Conclusions Elective primary THA in patients with Parkinson’s disease is associated with increased perioperative complications and substantially higher 90-day readmission with early revision and reoperation. These findings highlight increased post-discharge vulnerability in this population and underscore the need for enhanced perioperative optimization and postoperative surveillance. Levels of Evidence: Level III

To compare 90-day readmissions, complications, and resource use after robotic-assisted versus conventional total knee arthroplasty (TKA) in a contemporary, nationally representative cohort. Retrospective cohort study using the Nationwide Readmissions Database (NRD) 2020-2022. Primary TKA identified from the PR1 field (ICD-10-PCS). Exclusions included non-elective admissions, revisions, bilateral procedures, age < 18, oncology/fracture/reoperation, COVID-19, and discharges after September. Readmissions within 90days were categorized (prosthesis/SSI, mechanical/implant, VTE). 1:1 propensity score matching (nearest neighbor, caliper 0.01, no replacement) included demographics, comorbidities, hospital factors, and year. After matching, 96,982 patients (48,491 per group) were analyzed. Robotic TKA showed lower all-cause 90-day readmission (5.0% vs 6.5%), superior readmission-free survival (log-rank P < 0.001), shorter readmission LOS (4.8 vs 5.6days), and lower readmission charges ($66,769 vs $75,544), with slightly higher index charges ($78,125 vs $74,090). Risks were lower for VTE/PE, pneumonia, transfusion, postoperative pain, and prosthesis/SSI-related and mechanical readmissions. In the largest contemporary national analysis, robotic TKA was associated with fewer early complications, lower 90-day readmissions, and reduced readmission resource use compared with conventional TKA.

Abstract Background Surgical management of displaced femoral neck fractures in older adults typically involves hemiarthroplasty or total hip arthroplasty (THA). Although guidelines recommend THA for healthier, cognitively intact, community-dwelling adults, real-world procedure selection varies widely. This study evaluated nationwide determinantsfe of receiving THA versus hemiarthroplasty using a contemporary U.S. dataset. Methods A retrospective cohort study was conducted using the 2022 Nationwide Readmissions Database (NRD). Patients ≥ 65 years hospitalized with femoral neck fracture were identified using ICD-10-CM codes. Those treated with internal fixation or non-arthroplasty procedures were excluded. Weighted analyses characterized demographics, comorbidities, and hospital utilization between THA and hemiarthroplasty groups. A multivariable logistic regression model identified independent predictors of receiving THA. All analyses accounted for NRD survey design. Results Among 142,013 operative cases, 99,084 met inclusion criteria (81.8% hemiarthroplasty; 18.2% THA). Patients receiving THA were younger (76.6 vs 81.9 years), had shorter length of stay (6.06 vs 7.24 days), and were more frequently discharged home (17.5% vs 6.2%). Metabolic conditions were associated with increased odds of THA: obesity (OR 1.17), sleep apnea (OR 1.12), Frailty-related conditions were associated with markedly reduced THA likelihood, including Alzheimer’s disease (OR 0.48), Parkinson disease (OR 0.55), chronic kidney disease (OR 0.78), chronic lung disease (OR 0.73), and congestive heart failure (OR 0.69). Each additional year of age decreased the odds of THA by ~ 9%. Conclusion In this nationwide cohort, THA selection was strongly guided by patient age, frailty, and cognitive impairment, while metabolic comorbidities were associated with slightly higher THA utilization. These findings highlight real-world adherence to guideline-based patient selection and underscore the central role of functional reserve in treatment planning. Level of Evidence: Level III

The choice of a specific anatomic site for vaccine administration may influence rates of acceptance but has not been studied before. We conducted a randomized controlled trial in a pretravel clinic, comparing reported levels of satisfaction and pain on a scale of 0 to 10, and the frequency of adverse events (AEs) for vaccination in different anatomic sites. Travelers receiving one vaccine were randomized to be immunized in the deltoid or the vastus lateralis muscle. Travelers receiving multiple vaccines were randomized to be immunized in both the vastus lateralis and deltoid muscles or preferably in either the deltoid or the vastus lateralis muscles. For the 159 participants receiving multiple vaccines day 0 and day 7 satisfaction levels for the vastus lateralis, combined strategy or the deltoid injection sites were 9.00 ± 1.63, 9.46 ± 1.16 and 9.82 ± 0.52 (p = 0.001), and 6.62 ± 3.16, 8.87 ± 1.91 and 8.87 ± 2.05 (p < 0.001), respectively. For the 33 participants who received a single vaccine, day 0 and day 7 satisfaction levels for the vastus lateralis and deltoid muscles were 8.9 ± 2.2 and 10 ± 0.0 (p = 0.048) and 7.8 ± 2.7 and 9.8 ± 0.5 (p = 0.04), respectively. Pain levels on day 0 were similar across all study groups. However, muscle pain on day 7 was reported more frequently among participants vaccinated in the thigh region (61.7%) compared to those vaccinated in the deltoid muscle (31.9%) or at both sites (43.8%) (p < 0.01). Additionally, localized adverse events were reported more often by females (74.2%) than by males (48.8%) (p = 0.002). We found lower levels of satisfaction in travelers vaccinated in the thigh region. Such data may aid in increasing vaccination coverage and may influence practice guidelines. The trial was registered in accordance with local regulatory requirements under study identification number RMB518-18.

BackgroundSleep disorders are common in childhood and are recognized as a significant public health concern, particularly due to their association with childhood obesity. However, their impact on growth disturbances has been only minimally explored. In the present study, we investigate the association between sleep disorders and linear growth and excess weight in children.Study DesignData were collected retrospectively (January 2012–December 2022) from computerized medical records of 3,210 patients (newborn–18 years) diagnosed with sleep disorders who underwent sleep analysis at the Sleep Clinic of Carmel Medical Center. A control group (n =12,840), matched for age and ethnic background, was selected from the same healthcare database. Additionally, subgroup analyses were performed by sex and across three age groups.ResultsA higher rate of short stature, defined as height at or below the 3rd percentile, was observed in the study group compared to controls (8.66% vs. 6.25%, p < 0.001). This difference was primarily seen in the 0–6 years age group (girls: OR 1.49, p = 0.003; boys: OR 1.57, p < 0.001). The diagnosis of short stature and growth hormone deficiency was documented in 10.1% and 2.1% of the study group, respectively, compared to 7.5% and 1.15% in the control group (p < 0.001 for both). Rates of overweight and obesity were higher among children in the study group compared to controls (overweight: 25.9% vs. 22.2%; obesity: 14.6% vs. 10.4%; p < 0.001). This difference was primarily observed in children aged 6–18 years, with the strongest effects seen in adolescent boys. Notably, children with obstructive sleep apnea had a significantly higher prevalence of short stature compared to those with other sleep disorders (13.4% vs. 7.7%; p < 0.001).ConclusionsOur findings of a higher prevalence of growth disturbances and excess weight among children with sleep disorders highlight the importance of early recognition and timely intervention for pediatric sleep disorders. Such measures may improve sleep quality and daily functioning and potentially benefit growth and weight outcomes.

Vitamin D deficiency (VDD) is a widespread human condition closely associated with musculoskeletal disorders, involving alterations in body composition and systemic inflammation. In this cross-sectional study, 1075 adults were classified into a VDD (n = 304) group and a VD sufficient (VDS) group (n = 771). Body composition measurements, including the fat mass-to-weight ratio (FM/WT), were assessed using bioelectrical impedance analysis. Plasma levels of IL-9, IL-34, and MCP-1 were also measured. Data on osteoporosis (OP) and knee osteoarthritis (KOA) were collected. Regression analyses indicated that FM/WT was independently associated with VDD, which in turn was linked to elevated IL-34 levels. Individuals with VDD had a significantly higher prevalence of OP and KOA compared with those with VDS. Structural equation modeling confirmed and quantified these associations, suggesting that FM/WT is a significant predictor of VDD status (β = 0.305, 95% CI: 0.231–0.367). VDD is directly associated with elevated IL-34 levels (β = 0.353, 95% CI: 0.308–0.398), while IL-34 levels, in turn, are a possible cause of KOA (β = 0.573, 95% CI: 0.460–0.687) and OP (β = 0.433, 95% CI: 0.329–0.536). Our data clearly demonstrate existence of a physiological-pathological continuum: obesity-VDD-IL-34 and both OP and KOA.