Relationship between the Charlson Comorbidity Index and cost of treating hip fractures: implications for bundled payment

BackgroundThe aim of this study is to investigate how the Charlson Comorbidity Index (CCI) scores contribute to increased length of stay (LOS) and healthcare costs in hip fracture patients.ResultsMultivariate linear regression analysis modeled the length of stay as a function of CCI score. Each unit increase in the CCI score corresponded to an increase in length of hospital stay and hospital costs incurred [effect size = 0.21; (0.0434–0.381); p = 0.014]. Patients with a CCI score of 2 (compared to a baseline CCI score of 0), on average, stayed 1.92 extra days in the hospital, and incurred $8,697.60 extra costs.ConclusionsThe CCI score is associated with length of stay and hospital costs incurred following treatment for hip fracture. The CCI score may be a useful tool for risk assessment in bundled payment plans.

Level of evidence

Level III.     

Surgery for Graves’ disease: a 25-year perspective

Background

Optimal treatment of Graves’ disease (GD) remains controversial. The authors retrospectively reviewed the surgical cases of GD at a single academic tertiary center.

Methods

Demographic, clinical, and surgical data were analyzed for all patients with GD undergoing thyroidectomy over 25 years, in 3 periods: 1985 to 1993 (n = 32), 1994 to 2002 (n = 91), and 2003 to 2010 (n = 177).

Results

There were 300 patients with GD (85.7% women; mean age, 39.3 years; median length of follow-up, 24.6 months). Overall, perioperative morbidity occurred in 36 patients (12.0%), and there was no mortality. Thyroidectomy-specific morbidity was very low, and the incidental malignancy rate was 10.3%.

Conclusions

Surgical treatment of GD has a very high safety profile, with low perioperative and thyroidectomy-specific morbidity, even in patients with overt hyperthyroidism. Incidental malignancy in patients with GD is not uncommon.     

Recurrent carotid stenosis: operative strategy and late results

From 1957 to 1985, 116 consecutive operations for recurrent carotid stenosis were performed in 99 patients at the University of California, San Francisco. Ninety-four patients underwent 103 reoperations for primary recurrent stenosis (nine patients had bilateral repairs). Seventy-two operations (70%) were performed to relieve cerebrovascular symptoms whereas the indication for 31 operations (30%) was high-grade stenosis. The cause of primary recurrent stenosis was myointimal hyperplasia (MIH) in 47 cases, whereas 56 were caused by recurrent atherosclerosis (ASO). Secondary recurrent stenosis developed in six patients from our own series (5.8%) and an additional six patients were referred after reoperation elsewhere. The 12 lesions in this group were evenly divided between MIH (six) and recurrent ASO (six). MIH resulted in a single tertiary recurrent stenosis. Myointimectomy or repeat endarterectomy and vein patch angioplasty were the most commonly used techniques for repair of a primary recurrent stenosis. Secondary recurrent stenosis necessitated resection of the carotid bifurcation and graft interposition when caused by MIH. Secondary recurrent stenosis caused by ASO could be treated by repeat endarterectomy and vein patch angioplasty in five of six cases. Five strokes occurred in the entire series (4.3%), resulting in two deaths. There were 23 cranial nerve palsies, which rarely persisted beyond 3 months. The morbidity and mortality rates for primary and secondary carotid reoperation are comparable to the original procedure and should not deter the vascular surgeon from reoperative carotid reconstruction whenever indicated.     

Fertility and obstetric history in patients with familial Mediterranean fever on long-term colchicine therapy

The obstetric histories were examined for 36 women with familial Mediterranean fever (FMF) on long-term colchicine treatment followed for periods ranging between 3 and 12 years. Seven of 28 pregnancies (25%) associated with colchicine therapy ended in miscarriage. Thirteen women (36%) had periods of infertility; these were due to ovulatory dysfunction in six women, to peritoneal adhesions in four and remained unexplained in three women. The rates for miscarriage and infertility are high but are similar to those reported for women with FMF before colchicine therapy was introduced. All 16 infants born to mothers who had taken colchicine during pregnancy were healthy. Currently, we do not advise discontinuation of colchicine before planned pregnancy but recommend amniocentesis for karyotyping and reassurance.     

Functional-aesthetic reconstruction of periorbital fractures and defects

Patients with periorbital defects experience social rejection and psychological impairment as a result of their defect. We have developed a procedure to repair the defect which gives aesthetically and functionally satisfactory results. Infraorbital bony reconstruction and reconstruction of the intraorbital anatomical units are performed as primary surgery; supraorbital reconstruction is done secondarily. We make use of implants made of heath-polymerizing prefabricated polymethyl-methacrylate, and have had satisfactory results.