Background The implications of two-stage revision on mental health are poorly understood. The purpose of this study is to determine (1) whether patients undergoing two-stage revision total hip and knee arthroplasty for prosthetic joint infection were more likely to get Patient-Reported Outcomes Measurement Information System (PROMIS) Depression scores consistent with major depressive disorder (MDD) than those undergoing aseptic revision and (2) whether these symptoms resolved after the procedure. Methods Records of all 366 patients that underwent revision total hip or knee arthroplasty from January 1, 2015, – June 20, 2019, were reviewed. Forty-two patients were excluded for missing PROMIS Depression scores or incomplete treatment. Preoperative (<3 months), early postoperative (2-8 weeks), and final postoperative (6-18 months) Depression scores were collected. Patients crossing the PROMIS Depression threshold equivalent to a Patient Health Questionnaire-9 score ≥10, indicative of MDD, were evaluated. Results More two-stage revision patients developed Depression scores indicative of MDD perioperatively than the aseptic cohort (20.0% vs 6.5%, P = .01). Two-stage revision patients had higher (worse) median Depression scores preoperatively (54.8 vs 51.3, P = .04) and at early follow-up (54.3 vs 49.9, P = .01), but not at final follow-up (50.4 vs 49.1, P = .39). Across all patients, Depression scores improved by 2.4 points at early follow-up (95% confidence interval:1.1–3.7; P < .001) and 3 points at final follow-up (95% confidence interval:1.5-4.5; P < .001; minimal clinically important difference 3.0). Conclusions Twenty percent of two-stage revision arthroplasty patients, compared to <7% of aseptic revision patients, developed PROMIS Depression scores consistent with MDD during treatment. At final follow-up, a clinically significant improvement in Depression scores from baseline was evident in both cohorts.
Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) assesses multiple aspects of patient well-being but has not been thoroughly studied amongst orthopedic oncology patients. Questions/purposes: How do preoperative/early postoperative PROMIS scores compare in patients with benign versus malignant soft tissue tumors (STTs) for (1) physical function, (2) pain interference, and (3) depression? Are the differences clinically relevant? What other patient/tumor factors impact PROMIS? Methods: This retrospective cohort study included 314 STT patients who underwent resection of a benign (n = 187) or malignant (n = 127) STT over a period of 4.25 years at a single institution. PROMIS physical function, pain interference, and depression scores were collected preoperatively and at two and six weeks postoperatively. Scores for each time point were compared between groups and to preoperative baselines. Backward-stepwise linear mixed-effects models were produced to identify independent predictors of change in each PROMIS domain. The minimal clinically important difference (MCID) was 4 points. Results: The malignant cohort, but not the benign cohort, demonstrated clinically relevant worsening of physical function postoperatively. Malignant diagnosis (△ = −4.4, p < 0.001) and lower extremity tumors (△ = −4.5, p < 0.001) were identified as clinically relevant, independent predictors of worse physical function at all time points. No predictors of clinically relevant changes in pain interference or depression scores, including malignancy, were identified. Conclusions: In STT patients, malignancy and lower extremity STT location are associated with clinically relevant worsening in physical function but do not significantly impact pain interference or depression in the early postoperative period. These findings may help establish the utility of PROMIS in an orthopedic oncology population.
INTRODUCTION Hydrocephalus is a well-known and life-threatening sequel of traumatic brain injury (TBI) in adults, but is not as well characterized in children. We investigated the national incidence, risk factors, and outcomes associated with hydrocephalus in pediatric TBI. METHODS The Kids Inpatient Database (KID) is the largest pediatric hospital database in the U.S. and is sampled every 3 years. We queried the KID 2003, 2006, 2009, and 2012 using ICD-9-CM codes to identify all patients (age 0–20) with a primary diagnosis of TBI (850.xx 854.xx) and a secondary diagnosis code for hydrocephalus (331.3-331.5, excluding congenital hydrocephalus [742.3]. Variables included demographics, comorbidities, TBI severity (consciousness, type of wound) complications (medical or neurological), and discharge outcomes. Both univariate and multivariable analysis was utilized to identify factors associated with hydrocephalus and alpha was set at P < 0.05. RESULTS >In 124,444 patients hospitalized for TBI. The average rate of hydrocephalus was 1.0% but was affected by the type of TBI: subdural hematoma (2.4%), subarachnoid hemorrhage (1.4%), epidural hematoma (1.0%), cerebral laceration (0.9%), concussion (0.2%). The risk factors for hydrocephalus in multivariable analysis were age 0–5 (compared to other ages), Medicaid insurance, electrolyte disorder, chronic neurological condition, weight loss, subarachnoid hemorrhage, subdural hematoma, open wound, postoperative neurological complication, and septicemia (all P < 0.05). The likelihood of hydrocephalus was increased among surgically managed patients (6.0% vs. 0.5%) but decreased among those who underwent operation on admission day (0.8% vs. 4.1%) (both P < 0.05). The mortality rate for TBI patients without hydrocephalus was higher (5.4%) than those with hydrocephalus (1.1%). However, average LOS (25 vs. 5 days) and mean total hospital costs ($86,596 vs. $16,791) were greater among patients with hydrocephalus. CONCLUSION Hydrocephalus following TBI in children is relatively uncommon but is more likely in patients with certain demographics, pre-existing comorbidities, and injury patterns and attracts a higher total hospital cost.
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