Impact of modified-release opioid use on clinical outcomes following total hip and knee arthroplasty: a propensity score-matched cohort study

Modified-release opioids are often prescribed for the management of moderate to severe acute pain following total hip and knee arthroplasty, despite recommendations against their use due to increasing concerns regarding harm. The primary objective of this multicentre study was to examine the impact of modified-release opioid use on the incidence of opioid-related adverse events compared with immediate-release opioid use, among adult inpatients following total hip or knee arthroplasty. Data for total hip and knee arthroplasty inpatients receiving an opioid analgesic for postoperative analgesia during hospitalisation were collected from electronic medical records of three tertiary metropolitan hospitals in Australia. The primary outcome was the incidence of opioid-related adverse events during hospital admission. Patients who received modified with or without immediate-release opioids were matched to those receiving immediate-release opioids only (1:1) using nearest neighbour propensity score matching with patient and clinical characteristics as covariates. This included total opioid dose received. In the matched cohorts, patients given modified-release opioids (n = 347) experienced a higher incidence of opioid-related adverse events overall, compared with those given immediate-release opioids only (20.5%, 71/347 vs. 12.7%, 44/347; difference in proportions 7.8% [95%CI 2.3–13.3%]). Modified-release opioid use was associated with an increased risk of harm when used for acute pain during hospitalisation after total hip or knee arthroplasty.     

Dual-Energy Computed Tomography as an Adjunct in the Evaluation of Peripheral Chronic Total Occlusions: A Feasibility Study

This study investigated the role of dual-energy computed tomography (CT) for lesion characterization in patients with peripheral arterial disease manifesting with chronic total occlusions (CTOs). Forty-one symptomatic patients with CTOs underwent dual-energy CT angiography before endovascular treatment. The lesions were subsequently analyzed in a dedicated workstation, and 2 indexes—dual-energy index (DEI) and effective Z (Z_eff)—were calculated, ranging from 0.0027 to 0.321 and from 6.89 to 13.02, respectively. Statistical analysis showed a significant correlation between the DEI and Z_eff values (P < .001). The interobserver intraclass correlation coefficient was 0.91 for the mean Z_eff values and 0.86 for the mean DEI values. This technique could potentially provide useful information regarding the composition of a CTO.     

Comparison study of patient demographics and patient-related risk factors for peri-prosthetic joint infections following primary total shoulder arthroplasty

BackgroundWhile studies have demonstrated favorable outcomes in utilization of primary total shoulder arthroplasty (TSA) for the treatment of glenohumeral osteoarthritis (OA), adverse events such as infections can still occur. Periprosthetic joint infections (PJIs) are associated with worse outcomes and patient morbidity. The purpose of this study was to: (1) compare patient demographics amongst TSA patients with and without PJIs following primary TSA; and (2) identify patient-related risk factors for PJIs following primary TSA.MethodsPatients undergoing primary TSA for the treatment of glenohumeral OA were identified using the Mariner administrative claims database by CPT code 23,472. Laterality modifiers were utilized to ensure PJIs were developing in the correct laterality as those patients undergoing primary TSA. Inclusion for the study group consisted of patients who developed PJIs within 2-years after the index procedure, whereas patients who did not develop PJIs served as the comparison cohort. Primary outcomes analyzed included patient demographics and patient-related risk factors for PJIs following primary TSA. A stepwise backwards elimination multivariate binomial logistic regression analyses was performed to determine the odds (OR) of PJIs in patients undergoing primary TSA. A P value less than .05 was considered statistically significant.ResultsThe query yielded 15,396 patients who underwent primary TSA for glenohumeral OA, of which 191 patients developed PJIs and 15,205 did not develop PJIs. The study found statistically significant differences amongst patients who did and did not develop PJIs following primary TSA with respect to age, sex, and presence of comorbid conditions. Risk factors associated with developing PJIs following primary TSA included: pathologic weight loss (OR: 2.06, P < .0001), obesity (OR: 1.56, P = .0001), male sex (OR: 1.52, P = .007), and peripheral vascular disease (OR: 1.46, P = .022).ConclusionAs the number of primary TSAs for the treatment of glenohumeral OA increase worldwide, identifying modifiable risk-factors to reduce the incidence of infection is critical. The study found various modifiable and non-modifiable risk factors associated with developing PJIs following primary TSA. This study is valuable to orthopedists in order to identify and risk-stratify patients with regard to PJI in the setting of primary TSA for OA.Level of EvidenceLevel III; Case-Control Study     

微创超声乳化手术前后角膜前后表面及不同区域范围角膜参数的变化

目的：比较白内障微创超声乳化手术前后角膜前表面屈光力(ASF)、角膜真实净屈光力(TNP)和总角膜屈光力(TCRP)分布特点及角膜前后表面曲率半径比(B/F ratio)差异。

方法：前瞻性研究。收集2020-12/2021-05就诊于潍坊眼科医院行2.2mm微切口超声乳化白内障吸除联合人工晶状体植入术的年龄相关性白内障患者156例156眼。术前及术后3mo行Pentacam眼前节生物测量仪检查，收集以角膜顶点和以瞳孔为中心2、4、6mm环上和区域内ASF、TNP和TCRP，以及手术前后B/F ratio。

结果：术后3mo，以角膜顶点为中心2mm直径环上和区域内ASF值较术前均无差异(均P>0.05)，而4、6mm直径环上和区域内ASF值较术前均有差异(均P<0.05)； 以瞳孔为中心2mm直径环上及区域内ASF值较术前均无差异(均P>0.05)。以角膜顶点为中心和以瞳孔为中心2、4、6mm直径环上和区域内TNP、TCRP值较术前均有差异(均P<0.05)。术前以角膜顶点为中心和瞳孔为中心在2mm与6mm之间环上和4mm与6mm之间环上TCRP值均有差异(均P<0.0167)； 在2mm与6mm区域内TCRP值均有差异(均P<0.0167)； 术后3mo，以角膜顶点为中心和瞳孔为中心环上TCRP值在2mm与6mm之间、4mm与6mm之间均有差异(均P<0.0167)，而以角膜顶点为中心和瞳孔为中心区域内TCRP值仅在2mm与6mm直径范围内有差异(P<0.0167)。B/F ratio术前为81.79%±1.87%，术后3mo为80.68%±2.23%(P<0.001)。

结论：白内障手术前后以角膜顶点和以瞳孔为中心的不同直径环上及区域内各项角膜屈光力参数会有一定的变化和差异，人工晶状体度数计算的K值选择及基于角膜特性的人工晶状体个体化选择时应予以考虑。