The Journal of bone and joint surgery. American volume
-
J Bone Joint Surg Am · Aug 2018
Randomized Controlled TrialInterscalene Block with and without Intraoperative Local Infiltration with Liposomal Bupivacaine in Shoulder Arthroplasty: A Randomized Controlled Trial.
Interscalene brachial plexus blockade (ISBPB) is an effective anesthetic technique for shoulder arthroplasty; however, "rebound pain" can increase the patient's postoperative pain experience and narcotic usage. Exparel (liposomal bupivacaine) injected into the soft tissues at the surgical site has theoretical efficacy for up to 72 hours after administration. The purpose of this study was to evaluate postoperative pain scores and narcotic consumption following shoulder arthroplasty performed with either ISBPB alone or ISBPB and intraoperative Exparel. ⋯ Therapeutic Level l. See Instructions for Authors for a complete description of levels of evidence.
-
Waiting for hip fracture surgery is associated with complications. The objective of this study was to determine whether waiting for hip fracture surgery is associated with health-care costs. ⋯ Economic Level III. Please see Instructions for Authors for a complete description of levels of evidence.
-
J Bone Joint Surg Am · Aug 2018
Meta AnalysisRisk Factors and Pooled Rate of Prolonged Opioid Use Following Trauma or Surgery: A Systematic Review and Meta-(Regression) Analysis.
Prolonged use of opioids initiated for surgical or trauma-related pain management has become a global problem. While several factors have been reported to increase the risk of prolonged opioid use, there is considerable inconsistency regarding their significance or effect size. Therefore, we aimed to pool the effects of risk factors for prolonged opioid use following trauma or surgery and to assess the rate and temporal trend of prolonged opioid use in different settings. ⋯ Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
-
J Bone Joint Surg Am · Aug 2018
Observational StudyPatient Risk Factors Do Not Impact 90-Day Readmission and Emergency Department Visitation After Total Ankle Arthroplasty: Implications for the Comprehensive Care for Joint Replacement (CJR) Bundled Payment Plan.
The Comprehensive Care for Joint Replacement (CJR) model provides bundled payments for in-hospital care and care within 90 days following discharge for Medicare beneficiaries undergoing lower-extremity joint replacement involving the hip, knee, or ankle (total hip arthroplasty, total knee arthroplasty, or total ankle arthroplasty [TAA]). The study hypothesis was that patient comorbidities are associated with readmissions, emergency department (ED) utilization, and subspecialist wound-healing consultation, which are examples of costly contributors to postoperative health-care spending. ⋯ Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.