Purpose: Outpatient classified total hip arthroplasty (THA) is a safe option for a select group of patients. An analysis of a national database was conducted to understand the risk factors for unplanned discharge to a skilled nursing facility (SNF) or acute rehabilitation (rehab) after outpatient classified THA. Materials and Methods: A query of the National Surgical Quality Improvement Program (NSQIP) database for THA (Current Procedural Terminology [CPT] 27130) performed from 2015 to 2018 was conducted. Patient demographics, American Society of Anesthesiologists (ASA) classification, functional status, NSQIP morbidity probability, operative time, length of stay (LOS), 30-day reoperation rate, readmission rate, and associated complications were collected. Results: A total of 2,896 patients underwent outpatient classified THA. The mean age of patients was 61.2 years. The mean body mass index (BMI) was 29.6 kg/m 2 with median ASA 2. The results of univariate comparison of SNF/rehab versus home discharge showed that a significantly higher percentage of females (58.7% vs. 46.8%), age >70 years (49.3% vs. 20.9%), ASA ≥3 (58.0% vs. 25.8%), BMI >35 kg/m 2 (23.3% vs. 16.2%), and hypoalbuminemia (8.0% vs. 1.5%) (P<0.0001) were discharged to SNF/rehab. The results of multivariable logistic regression showed that female sex (odds ratio [OR] 1.47; P=0.03), age >70 years (OR 3.08; P=0.001), ASA≥3 (OR 2.56; P=0.001), and preoperative hypoalbuminemia (<3.5 g/dL) (OR 3.76; P=0.001) were independent risk factors for SNF/rehab discharge. Conclusion Risk factors associated with discharge to a SNF/rehab after outpatient classified THA were identified. Surgeons will be able to perform better risk stratification for patients who may require additional postoperative intervention.

Purpose: Acetabular and femoral offset (FO) play an important role in total hip arthroplasty (THA). The Sundsvall method has been proposed to account for both FO and cup offset in one global hip offset measurement. In this study, we examine the agreement and inter-observer reliability of the Sundsvall method of hip offset measurement. Materials and Methods: Four hundred and ninety-nine THA patients at a single tertiary academic institution were retrospectively reviewed. Preoperative hip offset was measured on anteroposterior radiographs of the pelvis on the operative and contralateral side. Hip offset was also measured postoperatively on the operative side. Hip offset was measured using the Sundsvall method as the distance between the femoral axis and midline of the pelvis at the height of the lateral most point of the greater trochanter. All measurements were completed by two raters. Intra-class correlation coefficients (ICC) and Pearson’s correlation coefficients were used to evaluate agreement and inter-observer reliability between two raters. Results: There was excellent agreement between raters for preoperative hip offset measurement with an ICC of 0.91 (confidence interval [CI] 0.90-0.93, P<0.01) and R=0.92. There was excellent agreement between raters for postoperative hip offset with an ICC of 0.93 (CI 0.92-0.94, P<0.01) and R=0.93. Conclusion This study confirms the inter-observer agreement and reliability of the Sundsvall method of hip offset measurement. With its high agreement and reliability, the Sundsvall method is an easy and reliable way to measure hip offset that can be applied in future clinical and research settings.

Purpose: Acetabular and femoral offset (FO) play an important role in total hip arthroplasty (THA). The Sundsvall method has been proposed to account for both FO and cup offset in one global hip offset measurement. In this study, we examine the agreement and inter-observer reliability of the Sundsvall method of hip offset measurement. Materials and Methods: Four hundred and ninety-nine THA patients at a single tertiary academic institution were retrospectively reviewed. Preoperative hip offset was measured on anteroposterior radiographs of the pelvis on the operative and contralateral side. Hip offset was also measured postoperatively on the operative side. Hip offset was measured using the Sundsvall method as the distance between the femoral axis and midline of the pelvis at the height of the lateral most point of the greater trochanter. All measurements were completed by two raters. Intra-class correlation coefficients (ICC) and Pearson’s correlation coefficients were used to evaluate agreement and inter-observer reliability between two raters. Results: There was excellent agreement between raters for preoperative hip offset measurement with an ICC of 0.91 (confidence interval [CI] 0.90-0.93, P<0.01) and R=0.92. There was excellent agreement between raters for postoperative hip offset with an ICC of 0.93 (CI 0.92-0.94, P<0.01) and R=0.93. Conclusion This study confirms the inter-observer agreement and reliability of the Sundsvall method of hip offset measurement. With its high agreement and reliability, the Sundsvall method is an easy and reliable way to measure hip offset that can be applied in future clinical and research settings.

Purpose: Acetabular and femoral offset (FO) play an important role in total hip arthroplasty (THA). The Sundsvall method has been proposed to account for both FO and cup offset in one global hip offset measurement. In this study, we examine the agreement and inter-observer reliability of the Sundsvall method of hip offset measurement. Materials and Methods: Four hundred and ninety-nine THA patients at a single tertiary academic institution were retrospectively reviewed. Preoperative hip offset was measured on anteroposterior radiographs of the pelvis on the operative and contralateral side. Hip offset was also measured postoperatively on the operative side. Hip offset was measured using the Sundsvall method as the distance between the femoral axis and midline of the pelvis at the height of the lateral most point of the greater trochanter. All measurements were completed by two raters. Intra-class correlation coefficients (ICC) and Pearson’s correlation coefficients were used to evaluate agreement and inter-observer reliability between two raters. Results: There was excellent agreement between raters for preoperative hip offset measurement with an ICC of 0.91 (confidence interval [CI] 0.90-0.93, P<0.01) and R=0.92. There was excellent agreement between raters for postoperative hip offset with an ICC of 0.93 (CI 0.92-0.94, P<0.01) and R=0.93. Conclusion This study confirms the inter-observer agreement and reliability of the Sundsvall method of hip offset measurement. With its high agreement and reliability, the Sundsvall method is an easy and reliable way to measure hip offset that can be applied in future clinical and research settings.

Purpose: Acetabular and femoral offset (FO) play an important role in total hip arthroplasty (THA). The Sundsvall method has been proposed to account for both FO and cup offset in one global hip offset measurement. In this study, we examine the agreement and inter-observer reliability of the Sundsvall method of hip offset measurement. Materials and Methods: Four hundred and ninety-nine THA patients at a single tertiary academic institution were retrospectively reviewed. Preoperative hip offset was measured on anteroposterior radiographs of the pelvis on the operative and contralateral side. Hip offset was also measured postoperatively on the operative side. Hip offset was measured using the Sundsvall method as the distance between the femoral axis and midline of the pelvis at the height of the lateral most point of the greater trochanter. All measurements were completed by two raters. Intra-class correlation coefficients (ICC) and Pearson’s correlation coefficients were used to evaluate agreement and inter-observer reliability between two raters. Results: There was excellent agreement between raters for preoperative hip offset measurement with an ICC of 0.91 (confidence interval [CI] 0.90-0.93, P<0.01) and R=0.92. There was excellent agreement between raters for postoperative hip offset with an ICC of 0.93 (CI 0.92-0.94, P<0.01) and R=0.93. Conclusion This study confirms the inter-observer agreement and reliability of the Sundsvall method of hip offset measurement. With its high agreement and reliability, the Sundsvall method is an easy and reliable way to measure hip offset that can be applied in future clinical and research settings.

OBJECTIVE: A growing interest in extracorporeal cardiopulmonary resuscitation (ECPR) as a rescue strategy for refractory adult out-of-hospital cardiac arrest (OHCA) currently exists. This study aims to determine current standards of care and practice variation for ECPR patients in the USA and Korea. METHODS: In December 2015, we surveyed centers from the Korean Hypothermia Network (KORHN) Investigators and the US National Post-Arrest Research Consortium (NPARC) on current targeted temperature management and ECPR practices. This project analyzes the subsection of questions addressing ECPR practices. We summarized survey results using descriptive statistics. RESULTS: Overall, 9 KORHN and 4 NPARC centers reported having ECPR programs and had complete survey data available. Two KORHN centers utilized extracorporeal membrane oxygenation only for postarrest circulatory support in patients with refractory shock and were excluded from further analysis. Centers with available ECPR generally saw a high volume of OHCA patients (10/11 centers care for >75 OHCA a year). Location of, and providers trained for cannulation varied across centers. All centers in both countries (KORHN 7/7, NPARC 4/4) treated comatose ECPR patients with targeted temperature management. All NPARC centers and four of seven KORHN centers reported having a standardized hospital protocol for ECPR. Upper age cutoff for eligibility ranged from 60 to 75 years. No absolute contraindications were unanimous among centers. CONCLUSION: A wide variability in practice patterns exist between centers performing ECPR for refractory OHCA in the US and Korea. Standardized protocols and shared research databases might inform best practices, improve outcomes, and provide a foundation for prospective studies.
Adult* ; Cardiopulmonary Resuscitation* ; Catheterization ; Coma ; Extracorporeal Membrane Oxygenation ; Heart Arrest ; Humans ; Hypothermia ; Korea ; Out-of-Hospital Cardiac Arrest* ; Practice Guidelines as Topic ; Prospective Studies ; Research Personnel ; Shock ; Standard of Care

The USA has a high burden of childhood asthma. Previous studies have observed associations between higher blood lead levels and greater hypersensitivity in children. The objective of the present study was to estimate the association between blood lead concentrations during early childhood and an asthma diagnosis between 48 and 72 months of age amongst a cohort with well-characterized blood lead concentrations. Blood lead concentrations were measured at 6, 12, 18, 24, 36, and 48 months of age in 222 children. The presence of an asthma diagnosis between 48 and 72 months was assessed using a questionnaire which asked parents or guardians whether they had been told by a physician, in the past 12 months, that their child had asthma. Crude and adjusted risk ratios (RR) of an asthma diagnosis were estimated for several parameterizations of blood lead exposure including lifetime average (6 to 48 months) and infancy average (6 to 24 months) concentrations. After adjustment for child sex, birthweight, daycare attendance, maternal race, education, parity, breastfeeding, income, and household smoking, age-specific or composite measures of blood lead were not associated with asthma diagnosis by 72 months of age in this cohort.
Asthma/etiology* ; Child ; Child, Preschool ; Cohort Studies ; Environmental Pollutants/blood* ; Female ; Humans ; Infant ; Infant, Newborn ; Lead/blood* ; Male ; New York/epidemiology*

Background: and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. Methods: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). Results: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. Conclusions During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.