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Elevated Distressed Community Index Score is Associated With Adverse Outcomes Following Hip Fracture Surgery in the Medicare Population
Background
Despite advances in surgical care, disparities in functional recovery and mortality following hip fracture directly relate to racial, ethnic, and economic factors. Without a comprehensive method to model patients’ diverse socioeconomic factors, researchers rely on proxies such as race and insurance status. The Distressed Community Index (DCI) score is a validated means of holistically estimating a patient’s socioeconomic status, incorporating variables including community median income, unemployment, housing vacancies, education, business growth, and poverty rates.
Methods
The 2012-2014 100% Medicare Standard Analytical Files was queried, identifying patients surgically treated for isolated hip fractures. Individual socio-economic status was determined by linking residential ZIP codes with the DCI score. The study cohort was divided into 5 distinct tiers based on the DCI score: [0-20] (prosperous), [21-40] (comfortable), [41-60] (mid-tier), [61-80] (at risk), and >80 (distressed). Multi-variate logistic regression analyses were used to assess the impact of increasing DCI score on 90-day complications, readmissions, and mortality.
Results
A total of 364 074 patients met inclusion criteria. Patients with lower DCI scores were more likely to receive care at teaching hospitals (13.1%) in urban settings (97.6%) than the Distressed tier (8.7% and 73.6%, respectively). The distressed group was at a significantly higher risk of urinary tract infections (OR 1.12; P < 0.001), pneumonia (OR 1.18; P < 0.001), and pressure ulcers (OR 1.09; P < 0.001). Patients in the distressed group were more likely to have emergency department visits (OR 1.12; P < 0.001) and had higher odds of mortality (OR 1.14; P < 0.001). With elevated DCI score there were lower rates of readmission (OR 0.91-0.95; P < 0.001) but this was not significant in the DCI >80 group.
Conclusions
Patients living in ZIP codes with high DCI score had higher risks of post-operative complications, including death, after hip fracture surgery. Integration of the DCI score into clinical practice may help to mitigate adverse outcomes in this vulnerable patient population.
Journal Article
Octogenarian and Nonagenarians Are at a Higher Risk for Experiencing Adverse 30-Day Outcomes Following ORIF of Ankle Fractures
Introduction:
Despite an increasing number of elderly individuals undergoing surgical fixation for ankle fractures, few studies have investigated peri-operative outcomes and safety of surgery in an octogenarian and nonagenarian population (age >80 years).
Materials and Methods:
The 2012-2017 American College of Surgeons database was queried for patients undergoing open reduction internal fixation for isolated uni-malleolar, bi-malleolar and tri-malleolar ankle fractures. The study cohort was divided into 3 comparison groups (age <65 years, 65-75 and >80). Multi-variate regression analyzes were used to compare the independent effect of varying age groups on 30-day post-operative outcomes while controlling for baseline clinical characteristics and co-morbidity burdens.
Results:
A total of 19,585 patients were included: 5.3% were >80 years, 18.1% were 65-79 years, and 76.6% were <65 years. When compared to the non-geriatric population, individuals >80 years were at a significantly Abstract: higher risk of 30-day wound complications (OR 1.84; p = 0.019), pulmonary complications (OR 3.88; p < 0.001), renal complications (OR 1.96; p = 0.015), septic complications (OR 3.72; p = 0.002), urinary tract infections (OR 2.24; p < 0.001), bleeding requiring transfusion (OR 1.90; p = 0.025), mortality (or 7.44; p < 0.001), readmissions (OR 1.65; p = 0.004) and non-home discharge (OR 13.91; p < 0.001).
Discussion:
Octogenarians undergoing ankle fracture fixation are a high-risk population in need of significant pre-operative surgical and medical optimization. With the majority of patients undergoing non-elective ORIF procedures, it is critical to anticipate potential complications and incorporate experienced geriatric providers early in the surgical management of these patients.
Conclusions:
Octogenarians and nonagenarians are fundamentally distinct and vulnerable age groups with a high risk of complications, readmissions, mortality and non-home discharges compared to other geriatric (65-79 years) and non-geriatric (<65 years) patients. Pre-operative counseling and risk-stratification are essential in this vulnerable patient population.
Journal Article
Asystole in a COVID-19 patient without systemic illness: a case report
ABSTRACT
There is growing evidence that patients with severe systemic illness from coronavirus disease 2019 (COVID-19) are at risk for developing a variety of cardiac arrhythmias. Less is known about patients with milder symptoms. Here, we report on the case of a 62-year-old male, admitted to the hospital following an episode of syncope, who experienced multiple episodes of cardiac arrest due to asystole lasting up to 30 seconds. History revealed a recent asymptomatic COVID-19 infection, and recurrent episodes of prolonged asystole necessitated permanent pacemaker placement. To our knowledge, this is the first report of an asymptomatic COVID-19 patient experiencing prolonged asystole. Cardiac arrhythmias in asymptomatic or oligosymptomatic COVID-19 patients may be underestimated.
Journal Article
Comparative Analysis of Frailty Indices on Complication Risk Following Septic Revision Total Hip and Knee Arthroplasty
Background
Frailty is an established risk factor for adverse outcomes following total joint arthroplasty, including higher rates of prosthetic joint infection (PJI), reoperation rates, and readmission, which may be greater in the setting of revision. The purpose of this study is to compare the association of frailty indices with mortality and complications following septic revision arthroplasty.
Methods
A query from The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) was performed for adult patients undergoing revision total knee or hip arthroplasty between 2015 and 2020, which records perioperative data (30 days postoperatively) for over 700 centers nationwide. PJI cases without revision arthroplasty were excluded. The RAI-rev and mFI-5 frailty scores were calculated for each patient. Outcomes included major complications, mortality, non-home discharge (NHD), DVT, readmission within 30 days, wound complications, pulmonary complications, cardiac complications, and postoperative infection. T-test and binary logistic regression assessed associations with frailty scores and outcomes. Predictability was evaluated through multivariate regression analysis, and its discriminative accuracy was measured using receiver operating curve (ROC) analysis and C-statistics.
Results
A total of 4395 patients were included (median age: 66 [IQR 59-73]). Within the cohort, 46.44% were female and 38.02% exhibited NHD. RAI-rev demonstrated increased association compared to mFI-5 with mortality (OR: 1.20 vs 1.10, CI: 95%) and NHD (OR: 1.15 vs 1.05, CI: 95%). RAI-Rev demonstrated significantly superior discriminatory accuracy when compared to mFI-5 for NHD (Cs: 0.670 vs 0.602, P < 0.001) and mortality (Cs: 0.795 vs 0.574, P < 0.001).
Conclusions
Frailty may have a distinct association with mortality and NHD following septic rTJA, especially when assessed by the revised Risk Analysis Index. This understanding is important to educate the patient and their family and provide insight into the necessary resources and surveillance needed to manage frail patients undergoing septic revision total joint arthroplasty.
Journal Article
EndoGenius: Enabling comprehensive identification and quantitation of endogenous peptides
The investigation of endogenous peptides, specifically with respect to neuropeptides, from mass spectrometry data is rife with bioinformatics bottlenecks, stemming from the low
abundance of these analytes, increased susceptibility to degradation, and an immense search space of possible peptides. To address this, we present EndoGenius in its expanded form, strategically designed to optimize the searching for these endogenous peptides complemented with a pipeline designed for tasks including quantitation, spectral library building, motif extraction, and usage with data-independent acquisition workflows.
EndoGenius is released as an open-source software package under an MIT License. The EndoGenius package with a user interface can be installed from https://www.lilabs.org/resources . The source code for EndoGenius can be accessed at https://github.com/lingjunli-research/EndoGenius-v2.0 .
Lingjun.Li@wisc.edu.
Journal Article
Unlocking the Neuropeptidome using a Novel Endogenous Peptidomics Framework
Endogenous peptides have garnered increasing attention over the past decade driven by the development of advanced analytical methods. However, large-scale investigations of peptides as potential disease biomarkers or drug candidates are still hindered by their challenging biochemical properties and the scarcity of specialized analytical tools. Among these, neuropeptides are particularly challenging to study due to their low
concentration, rapid turnover rate, and high structural variability. Data-independent acquisition (DIA) mass spectrometry (MS) has shown great ability in profiling low-abundance ions. Nevertheless, most available DIA analytical tools are designed for proteomics studies and are not suitable for endogenous peptides, as there is no set enzymatic cleavage for these peptides. Here, we introduce the novel EndoGenius platform, paired with DIA-NN, to achieve high-confidence neuropeptide identification using an updated spectral library for DIA MS analysis. By employing orthogonal offline fractionation, ion mobility instrumentation, and an optimized database searching algorithm specifically for neuropeptides, we have constructed the largest crustacean neuropeptide spectral library to date. With this library, in combination with neural networking technology, we report a 100-fold increase in the number of neuropeptides identified in all
tissues analyzed. We also cross-validated these findings with transcriptomics data to enhance identification confidence. This workflow presents a novel analytical framework for DIA peptidomics analysis, offering a robust approach to studying neuropeptides and other endogenous peptides.
We present a framework that capitalizes on robust analytical innovations and an optimized bioinformatics pipeline to provide the most comprehensive snapshot of the crustacean neuropeptidome to-date.
Journal Article
\That Heart Sickness\: Exploring Aboriginal Young People's Experiences of Rheumatic Fever Care from Childhood to Adulthood
The burden of rheumatic fever is almost entirely borne by young Aboriginal people in northern and remote locations in Australia while it has been nearly eradicated in other parts of the nation. Epidemiological studies are vital for highlighting disease patterns and for advocating for action. Equally important is to understand how the disease and health care dynamics are perceived by those affected by the condition in order to gain a more complete picture and to inform nuanced care, prevention and advocacy strategies. These include strategies for administering the regular painful penicillin injections that young people endure for at least one decade once they have acquired rheumatic fever, to protect their hearts.An ethnographic study was undertaken to explore the perceptions, knowledge and understandings that young Aboriginal people and their families have of rheumatic fever and resultant rheumatic heart disease, as well as the health care they receive, including the longterm injection regimen. The ethnography was undertaken in four remote sites in the Northern Territory between 2013 and 2016 as part of a larger community-randomised trial.No families understood these physiologically complex diseases or knew why the injections were needed, apart from to “keep their heart strong”. In addressing these diseases, it is paramount that the indelible sociocultural characteristics of the affected population, such as language and world view, are recognised and valued and that health care design takes account of these characteristics rather than simply practising biomedicine. Recognising the deep historical and political stories of the affected populations is vital for understanding the determinants driving rheumatic fever. The complexity of risk factors means that collaboration with other disciplines outside of biomedicine is required to work towards real change. But, crucially, improvements must be undertaken in proper partnership with local Aboriginal people.
Dissertation
The tactics employed by G-8 protesters later...
The tactics employed by G-8 protesters later this month will depend on the circumstances, says a well-known Canadian activist, who refused to condemn the use of violence.
Newsletter
A woman who faces a lawsuit from...
A woman who faces a lawsuit from the public guardian and trustee of British Columbia for having her mentally disabled son sterilized says she took the step for the sake of her childs freedom. The case was discussed on a Global Sunday television panel.
Newsletter