Noise pollution decreases effective intraoperative communication during PCNL. It is important for surgeons to understand the effect noise can have on attempted communication to prevent errors due to miscommunication. In addition, methods to decrease intraoperative noise pollution and improve communication in the OR could improve patient safety and outcomes.

Background The use of marijuana in the USA has been steadily increasing over the last 10 years. This study is the first to investigate the effect of marijuana use by live kidney donors upon outcomes in both donors and recipients. Methods Living kidney donor transplants performed between January 2000 and May 2016 in a single academic institution were retrospectively reviewed. Donor and recipient groups were each divided into two groups by donor marijuana usage. Outcomes in donor and recipient groups were compared using t -test, Chi-square and mixed linear analysis (P < 0.05 considered significant). Results This was 294 living renal donor medical records were reviewed including 31 marijuana-using donors (MUD) and 263 non-MUDs (NMUD). It was 230 living kidney recipient records were reviewed including 27 marijuana kidney recipients (MKRs) and 203 non-MKRs (NMKR). There was no difference in donor or recipient perioperative characteristics or postoperative outcomes based upon donor marijuana use (P > 0.05 for all comparisons). There was no difference in renal function between NMUD and MUD groups and no long-term difference in kidney allograft function between NMKR and MKR groups. Conclusions Considering individuals with a history of marijuana use for living kidney donation could increase the donor pool and yield acceptable outcomes.

Study Design. A retrospective database study.Objective. The purpose of our study was to compare the perioperative complications and reoperation rates after anterior cervical discectomy and fusion (ACDF), cervical disk arthroplasty (CDA), and posterior cervical foraminotomy (PCF) in patients treated for cervical radiculopathy. Summary of Background Data. Cervical radiculopathy results from compression or irritation of nerve roots in the cervical spine. While most cervical radiculopathy is treated nonoperatively, ACDF, CDA, and PCF are the techniques most commonly used if operative intervention is indicated. There is limited research evaluating the perioperative complications of these surgical techniques. Materials and Methods. A retrospective review was performed using the PearlDiver Patient Record Database to identify cases of cervical radiculopathy that underwent ACDF, CDA, or PCF at one or two levels from 2007 to 2016. Perioperative complications and reoperations following each of the procedures were assessed. Results. During the study period, 25,051 patients underwent ACDF, 522 underwent CDA, and 3986 underwent PCF. After propensity score matching, each of the three groups consisted of 507 patients. Surgical site infection rates were highest after PCF (2.17%) compared with ACDF (0.20%) and CDA (0.59%) at 30 days and three months (P = 0.003, P < 0.001), respectively. New-onset cervicalgia was highest following ACDF (34.32%) and lowest after PCF (22.88%) at three and six months (P < 0.001 and P = 0.003), respectively. Revision surgeries were highest among those who underwent CDA (6.90%) versus ACDF (3.16%) and PCF (3.55%) at six months (P = 0.007). Limb paralysis was significantly higher after PCF compared with CDA and ACDF at six months (P < 0.017). Conclusions. The rate of surgical site infection was higher in PCF compared with ACDF and CDA. New-onset cervicalgia was higher after ACDF compared with PCF and CDA at short-term follow-up. Revision surgeries were highest among those undergoing CDA and lowest in those undergoing ACDF.

BackgroundRiding off-road vehicles is associated with the risk of injury to the extremities. There are two main types of four-wheel recreational off-road vehicles: quads or all-terrain vehicles (ATVs), which are essentially four-wheel off-road motorcycles, and recreational off-highway vehicles (ROVs), also colloquially referred to as utility terrain vehicles, which have side-by-side seating, higher maximum speeds, and a roll cage. There are multiple orthopaedic society position statements on ATVs, but none on ROVs. Perhaps this is because the injury patterns and differences between the two vehicles have not been elucidated.Questions/purposes(1) What patient, vehicle (ROVs versus ATVs), and injury factors are associated with amputation? (2) What are the anatomic location distributions of fractures and amputations by vehicle type?MethodsRecords of all patients in our hospital’s billing system who had both a diagnostic code indicating an accident related to an off-road vehicle and one indicating an extremity or pelvic fracture between February 2014 and January 2020 were screened; this resulted in the identification of 328 patients with fractures resulting from off-road vehicle collisions. A total of 16% (51 of 328) of patients were excluded from the analysis because their injury did not involve either an ATV or an ROV; 277 patients were included in the final analysis. The following variables were collected: age at time of the injury, gender, BMI, vehicle type, Gustilo-Anderson type if applicable, amputation level if applicable, anatomic locations of injuries, ethanol level, and drug screen. ATV crashes accounted for 52% (145 of 277) of patients, and ROV crashes accounted for 48% (132 of 277). Patients from ATV crashes did not differ from those in ROV crashes in terms of mean age (24 ± 16 years versus 24 ± 13 years; p = 0.82), BMI (25 ± 7 kg/m2 versus 26 ± 6 kg/m2; p = 0.18), or gender (79% [114 of 145] men/boys versus 77% [102 of 132]; p = 0.79). Among patients who had a drug or ethanol screen, there was a higher percent of ATV riders who used marijuana (39% [19 of 49] versus 17% [7 of 42]; p = 0.04), but there were no differences in abnormal blood alcohol screen or abnormal nonmarijuana drug screen; however, these results were available in only about one-third of patients (99 of 277 for ethanol and 91 of 277 for drug screen). Statistical analysis was performed using logistic regression analysis for factors associated with amputation, with p values < 0.05 considered significant.ResultsAfter controlling for differences in demographic factors, the stepwise increase in Gustilo-Anderson grade of open fracture (OR 9.8 [95% CI 3.6 to 27.0]; p < 0.001) and ROV vehicle type (OR 15.7 [95% CI 3.6 to 68.5]; p < 0.001) were both associated with amputation. There was no increase in the odds of amputation associated with age (OR 1.0 [95% CI 0.9 to 1.1]; p = 0.81), gender (OR 1.4 [95% CI 0.3 to 5.8]; p = 0.68), or BMI (OR 1.1 [95% CI 0.9 to 1.2]; p = 0.37). The most frequent ATV fractures occurred in the forearm and wrist (...

A computer-assisted needle guidance system increases effective US targeting for renal access and mass biopsy for novice and experienced users.

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Background The cost and stress of applying to residency programs are increasing. Planning for interviews with limited lead time can cause additional burden to residency applicants. Objective We sought to determine if the specialty of orthopaedics was affording the same lead time between interview invitation and interview dates as its surgical and medical counterparts. Methods Dates for the first interview invitation and last possible interview were gathered for each program in orthopaedic surgery, general surgery, otolaryngology, vascular surgery, plastic surgery, neurological surgery, internal medicine, psychiatry, pediatrics, and family medicine. Interview lead time was calculated for each specialty. Mann–Whitney U and independent sample Kruskal-Wallis tests were used for nonparametric data with P &lt; .05 considered as significant. Results Orthopaedic surgery lead time is significantly different when compared individually and pairwise to other specialties (P &lt; .05 for all comparisons), with a median lead time of 57 days. The next lowest lead time specialty is otolaryngology with a 70-day lead time. The specialty with the longest is pediatrics (median 106 days). Conclusions Residency programs (orthopaedic surgery in particular) vary widely in the amount of lead time given to schedule and attend interviews. The authors propose that interview invitations be extended into mid-October.

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