Iowa Orthopaedic Center

The purpose of this study was to determine the patient-driven and surgical characteristics that drive day-of-surgery (DOS) costs for repair of isolated supraspinatus tears. All patients who underwent primary rotator cuff repair (RCR) for isolated supraspinatus tears within one health care system from 2016 to 2022 were inclusion eligible. Exclusion criteria included concomitant tear of infraspinatus, teres minor, or subscapularis; previous RCR or fractures of affected shoulder; diagnosis of rheumatoid arthritis; and incomplete baseline or 1-year patient-reported outcomes. Patient demographic information, injury characteristics, surgical technique/supplies, operative time stamps, symptomatic retear, and reoperation rates data were extracted from patients' electronic medical records and retrospectively reviewed. Time-driven activity-based costing was derived from direct and indirect DOS cost of care. A total of 236 patients who underwent primary RCR for isolated supraspinatus tears from 2016 to 2022 were included. The average DOS cost was $2,443 ± $832. The average implant cost was $1,066 ± $654, accounting for 87% of variation in DOS costs. Upon univariate analysis, depression (p = 0.045), full-thickness tears (p < 0.001), double-row repair (p < 0.001), subacromial decompression (p < 0.001), distal clavicle excision (p = 0.003), biceps tenodesis (p < 0.001), number of suture anchors (p < 0.001), and operating surgeon (p < 0.001) were associated with higher DOS costing. Multivariable linear regression analysis using characteristics that demonstrated statistical significance on univariate analysis revealed that depression, full-thickness tears, double-row repairs, subacromial decompression, distal clavicle excision, biceps tenodesis, and number of suture anchors were significant predictors of cost (p < 0.05). Significant predictors of DOS costing for isolated supraspinatus RCRs include depression, full-thickness tear, double-row repair, subacromial decompression, distal clavicle excision, biceps tenodesis, number of suture anchors, and operating surgeon. Providing surgeons with this information can enable greater cost-transparency and, in conjunction with clinical judgement and patient preference, better equip them to deliver high-quality value-based care. Level IV. See Instructions for Authors for a complete description of levels of evidence.

Femoral access is the gold standard fortranscatheter aortic valve replacement (TAVR). Safe alternative access, that represents about 15% of TAVR cases, remains important for patients without adequate transfemoral access. We aimed to perform a systematic review and meta-analysis of studies comparing transfemoral (TF) access versus transsubclavian or transaxillary (TSc/TAx) access in patients undergoing TAVR. We searched PubMed, Cochrane CENTRAL Register, EMBASE, Web of Science, Google Scholar and ClinicalTrials.gov (inception through May 24, 2022) for studies comparing (TF) to (TSc/TAx) access for TAVR. A total of 21 studies with 75,995 unique patients who underwent TAVR (73,203 transfemoral and 2,792 TSc/TAx) were included in the analysis. There was no difference in the risk of in-hospital and 30-day all-cause mortality between the two groups (RR 0.64, 95% CI 0.36-1.13, P=0.12) and (RR 0.95, 95% CI 0.64-1.41, P=0.81), while 1-year mortality was significantly lower in the TF TAVR group (RR 0.79, 95% CI 0.67-0.93, P=0.005). No significant differences in major bleeding (RR 0.82, 95% CI 0.65-1.03, P=0.09), major vascular complications (RR 1.14, 95% CI 0.75-1.72, P=0.53), and stroke (RR 0.66, 95% CI 0.42-1.02, P=0.06) were observed. In patients undergoing TAVR, TF access is associated with significantly lower 1-year mortality compared to TSc/TAx access without differences in major bleeding, major vascular complications and stroke. While TF is the preferred approach for TAVR, TSc/TAx is a safe alternative approach. Future studies should confirm these findings, preferably in a randomized setting.

Introduction: There are significant differences in body composition by sex; however, differences by sex on the association of BMI with cardiovascular outcomes after STEMI remains poorly understood. Methods: The Midwest STEMI Consortium consists of 15,039 consecutive STEMI activations. 4,682 patients with 1-year follow-up were included to examine sex-differences in characteristics, treatment, in-hospital and 1-year MACE and mortality risk by BMI groups: normal (18.5-24.9 kg/m 2 ), overweight (25.0-29.9 kg/m 2 ), and obese (≥30.0 kg/m 2 ). Results: Among 4,682 patients, 30% were women and 70% were men. Among women, 28% had normal BMI, 30% were overweight, and 42% obese. In normal BMI patients women were significantly older, had higher rates of HTN, lower rates of smokers, lower peak troponin, and longer door-to-balloon times compared to men. Women had lower risk of 30-day MACE (1.1% vs. 3%, p=0.045) but there were no sex-differences in 1-year MACE or mortality. Among overweight patients, women were significantly older, had higher rates of HTN and diabetes, and lower rates of smokers. Bleeding complication was more common in women (38% vs. 32%, p=0.03) as was cardiogenic shock pre-PCI (13% vs. 8.8%, p=0.02) but no sex-differences were seen in 1-year MACE or mortality. Among obese patients, women were significantly older and had higher rates of HTN, diabetes and stroke. Women had lower rates of out of hospital cardiac arrest (8.8% vs. 13%, p=0.005) and more bleeding complication (39% vs. 33%, p=0.025). Women had higher risk of 30-day death (2% vs. 0.8%, p=0.02), 1-year stroke (2.4% vs. 0.7%, p=0.004), and 1-year MACE and mortality (Figure). Discussion: Among STEMI patients, we found that obese women were at increased risk of MACE and mortality. Interestingly, there were no differences in MACE or mortality between men and women of normal and overweight BMI ranges, suggesting the importance of BMI when risk stratifying patients, particularly women, that warrants further research.

This study aims to determine the effect of resilience, as measured by the Brief Resilience Scale (BRS), and perceived self-efficacy of knee function, as measured by the Single Assessment Numeric Evaluation (SANE) score on return to sport outcomes following ACL Reconstruction (ACLR) surgery. Seventy-one patients undergoing ACLR surgery were followed up for a minimum of one year. At six-months post-op, ACLR patients completed the BRS and the SANE score. Patients were stratified into low, normal, and high resilience groups, and outcome scores were calculated. The median return to sports participation, in months post-operatively, for the low, normal, and high resiliency groups were 7.1, 7.3, and 7.2 months, respectively (P=0.78). A multiple logistic regression analysis revealed that the SANE score was a significant predictor of return to sport at nine months when adjusted for age, sex, and BRS score (P=0.01). Patients that returned to sport by nine months demonstrated a mean SANE score of 92.7, compared to a mean of 85.7 (P=0.08). In patients who had returned to sport, neither the BRS resilience group nor the SANE score were significant predictors of the returned level of competition status (P=0.06; P=0.18). The SANE score may serve as a significant predictor of return to sport when adjusted for age, sex, and BRS score. Resilience, as measured by the BRS, was not significantly associated with return to sport, but may have utility in specific patient populations.