ATAK cells accumulated in target organs with distinct profiles, depending on the microbial etiology of infection. Finally, generation of an anti-ATAK immune response may provide an important safety mechanism that helps clear the cells from the host as the marrow recovers.
Same-day discharge pathways in total knee arthroplasty (TKA) are gaining popularity as a means to increase patient satisfaction and reduce overall costs, but these pathways have not been thoroughly evaluated in potentially at-risk populations, such as in patients ≥80 years old. The purpose of this study was to compare 90-day complications and mortality following same-day discharge after primary TKA in patients ≥80 years old and those <80 years old. Patients who underwent unilateral primary TKA, were discharged on postoperative day 0, and had a minimum 90-day follow-up were identified in a national insurance claims database (PearlDiver Technologies) using Current Procedural Terminology code 27447. These patients were stratified into two cohorts based upon age: (1) nonoctogenarians (<80 years old) and (2) octogenarians (≥80 years old). These cohorts were propensity matched based upon sex, Charlson comorbidity index, and obesity status. Univariate analysis was performed to determine differences in 90-day complications and mortality between the two cohorts. In total, 1,111 patients were included in each cohort. Both cohorts were successfully matched, with no observed differences in matched parameters for demographics or comorbidities. There was no significant difference in 90-day mortality between the two cohorts (p = 0.896). However, octogenarians were at significantly increased risk of postoperative atrial fibrillation (20.8 vs. 10.4%; p < 0.001), nonatrial fibrillation arrhythmias (8.4 vs. 5.6%; p = 0.009), pneumonia (4.5 vs. 2.2%; p = 0.002), stroke (3.1 vs. 1.7%; p = 0.037), heart failure (10.5 vs. 7.5%; p = 0.012), and urinary tract infection (UTI; 14.3 vs. 9.4%; p < 0.001) compared with the nonoctogenarian cohort. Relative to matched controls, octogenarians were at significantly increased risk of numerous 90-day medical complications following same-day primary TKA, including cardiopulmonary complications, stroke, and UTI. Clinicians should be cognizant of these complications and counsel patients appropriately when electing to perform same-day TKA in the octogenarian population.
Background Total hip arthroplasty (THA) is a historically popular and successful operation. While many steps of the operation are consistent between practitioners, discussion around which approach constitutes the “best” approach for routine, primary THA remains an open question. Objective The purpose of this study was to determine the effects of the surgical approach on hospital length of stay (LOS), hospital costs, and complication rates. A multisurgeon review of a single hospital was conducted to evaluate three surgical approaches: superior (SA), posterior (PA), and direct anterior (DAA). Methods All elective primary THAs performed between July 2013 and July 2016 were reviewed in an administrative database. Two surgeons performed SA, three surgeons performed PA, and two surgeons performed DAA. A total of 1,799 arthroplasties were analyzed: 980 (SA), 685 (PA), and 134 (DAA). Multivariate logistic, Poisson, and linear regression models were used to calculate the effects of each approach on LOS, cost, and per cent discharge home while adjusting for age, severity of illness scores, obesity, and smoking. Results After adjusting for patient characteristics, mean LOS for SA (1.8 days) was lower than both PA (2.4, p < 0.001) and DAA (2.9, p < 0.001), and PA (2.4) was lower than DAA (2.9, p < 0.001). Mean hospital costs were lower for SA than PA ($738 difference, p < 0.001) and DAA ($2,222 difference, p < 0.001), and PA was lower than DAA ($1,420 difference, p < 0.001). Both SA (88.7%) and PA (86.1%) were associated with a higher rate of discharge to home than DAA (78.4%, p = 0.002, p < 0.001, respectively). SA and PA were associated with a lower 30-day readmission (1.3%) compared with DAA (5.2%, p < 0.001) with no difference in 90-day readmissions seen. Conclusion When controlling for patient factors, the SA was associated with a decreased LOS, decreased costs, and increased likelihood of discharge home compared with both the PA and DAA with no increase in 90-day readmissions.
Race and class are major predictors of health outcomes in the United States. Health disparities among racial and low-income minorities often have environmental etiologies. Using Rhode Island as a case study, we geocoded and visualized several environmental determinants of health via Geographic Information Systems (GIS) in the entire state and conducted a geospatial analysis to determine whether or not patterns existed along racial and class lines. The variables that we geocoded include elementary schools, fast food restaurants, Superfund sites, and community parks. From a census tract level, we then analyzed the racial and income makeup of each geocoded site. We discovered that, on average, the worst-performing elementary schools, fast food restaurants, and Superfund sites in Rhode Island were clustered in neighborhoods with a larger black population and lower household income. Conversely, community parks and the best elementary schools in Rhode Island tended to be located near neighborhoods with a larger White population and higher household income. Our results provide additional evidence for the pervasiveness of the unequal distribution of environmental health burdens between low-income, minority communities and affluent, predominantly White communities. This summer experiential student project demonstrates the feasibility of incorporating GIS as a practical tool for learning health disparities material at a U.S. medical school. Our study also highlights the value of digital technology and citizen science in helping the public recognize and understand the various environmental factors that perpetuate health disparities.
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