Safe and effective perioperative analgesia is instrumental to patient satisfaction and decreasing LOS after TJA. We evaluated rates of acute kidney injury (AKI) in primary and revision TJA using a multimodal pain control regimen including scheduled celecoxib and PRN ketorolac. Postoperative AKI was identified in 43/903 (4.8%) of 903 of patients with adequate preoperative renal function. Those who developed AKI had significantly increased LOS (P < .01), were older, more obese, and more likely to have diabetes (P < .05). With a protocol incorporating NSAIDs in patients without evidence of preoperative renal impairment, there is a 4.8% rate of AKI, which is 2.7 times higher than the reported literature. Acute postoperative kidney injury was significantly correlated with increased LOS and has important patient safety and healthcare-related cost implications.

Background Acceptance and commitment therapy (ACT) is a pragmatic approach to help individuals decrease avoidable pain. Objective This study aims to evaluate the effects of ACT delivered via an automated mobile messaging robot on postoperative opioid use and patient-reported outcomes (PROs) in patients with orthopedic trauma who underwent operative intervention for their injuries. Methods Adult patients presenting to a level 1 trauma center who underwent operative fixation of a traumatic upper or lower extremity fracture and who used mobile phone text messaging were eligible for the study. Patients were randomized in a 1:1 ratio to either the intervention group, who received twice-daily mobile phone messages communicating an ACT-based intervention for the first 2 weeks after surgery, or the control group, who received no messages. Baseline PROs were completed. Two weeks after the operative intervention, follow-up was performed in the form of an opioid medication pill count and postoperative administration of PROs. The mean number of opioid tablets used by patients was calculated and compared between groups. The mean PRO scores were also compared between the groups. Results A total of 82 subjects were enrolled in the study. Of the 82 participants, 76 (38 ACT and 38 controls) completed the study. No differences between groups in demographic factors were identified. The intervention group used an average of 26.1 (SD 21.4) opioid tablets, whereas the control group used 41.1 (SD 22.0) tablets, resulting in 36.5% ([41.1-26.1]/41.1) less tablets used by subjects receiving the mobile phone–based ACT intervention (P=.004). The intervention group subjects reported a lower postoperative Patient-Reported Outcome Measure Information System Pain Intensity score (mean 45.9, SD 7.2) than control group subjects (mean 49.7, SD 8.8; P=.04). Conclusions In this study, the delivery of an ACT-based intervention via an automated mobile messaging robot in the acute postoperative period decreased opioid use in selected patients with orthopedic trauma. Participants receiving the ACT-based intervention also reported lower pain intensity after 2 weeks, although this may not represent a clinically important difference. Trial Registration ClinicalTrials.gov NCT03991546; https://clinicaltrials.gov/ct2/show/NCT03991546

Background: Postoperative complications and substantial loss of physical function are common after musculoskeletal trauma. We conducted a prospective randomized controlled trial to assess the impact of conditionally essential amino acid (CEAA) supplementation on complications and skeletal muscle mass in adults after operative fixation of acute fractures.Methods: Adults who sustained pelvic and extremity fractures that were indicated for operative fixation at a level-I trauma center were enrolled. The subjects were stratified based on injury characteristics (open fractures and/or polytrauma, fragility fractures, isolated injuries) and randomized to standard nutrition (control group) or oral CEAA supplementation twice daily for 2 weeks. Body composition (fat-free mass [FFM]) was measured at baseline and at 6 and 12 weeks postoperatively. Complications were prospectively collected. An intention-to-treat analysis was performed. The relative risk (RR) of complications for the control group relative to the CEAA group was determined, and linear mixed-effects models were used to model the relationship between CEAA supplementation and changes in FFM.Results: Four hundred subjects (control group: 200; CEAA group: 200) were enrolled. The CEAA group had significantly lower overall complications than the control group (30.5% vs. 43.8%; adjusted RR = 0.71; 95% confidence interval [CI] = 0.55 to 0.92; p = 0.008). The FFM decreased significantly at 6 weeks in the control subjects (-0.9 kg, p = 0.0205), whereas the FFM was maintained at 6 weeks in the CEAA subjects (20.33 kg, p = 0.3606). This difference in FFM was not seen at subsequent time points. Conclusions:Our results indicate that CEAA supplementation has a protective effect against common complications and early skeletal muscle wasting after operative fixation of extremity and pelvic fractures. Given the potential benefits of this inexpensive, low-risk intervention, multicenter prospective studies in focused trauma populations are warranted.Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. Despite continued advances in surgical management of extremity and pelvic fractures, complications and prolonged loss of function continue to adversely impact clinical outcomes 1-5 . In the musculoskeletal trauma population, malnutrition is common, and when diagnosed by a registered dietitian, it is associated with a 3-fold greater complication rate 6 . Malnutrition is a potentially modifiable risk factor for mortality, fracture nonunion, wound complications, and increased length of stay [6][7][8][9] .Baseline malnutrition is further compounded by inadequate calorie and protein intake following trauma and subsequent surgery 10,11 . An already poor diet is further suppressed by pain, medication side effects, and nausea, leading to worsening nutrition deficiencies and limiting healing potential. These deficiencies, in combination with the detrimental effects of prolonged immobilization, result in a catabolic state with d...

BACKGROUND Acceptance and Commitment Therapy (ACT) is a pragmatic approach to help individuals decrease avoidable suffering and pain. OBJECTIVE To evaluate the effects of Acceptance and Commitment Therapy (ACT) delivered via an automated mobile messaging robot on postoperative opioid utilization and patient reported outcomes (PROs) in orthopaedic trauma patients who underwent operative intervention for their injuries. METHODS Adult patients presenting to a Level 1 trauma center who underwent operative fixation of a traumatic upper or lower extremity fracture and who utilized mobile phone text messaging were eligible for the study. Patients were randomized in a 1:1 ratio to either the intervention group, who received twice-daily mobile phone messages communicating an ACT-based intervention for the first two weeks after surgery, or the control group, who received no messages. Baseline PROs were completed. Two weeks after operative intervention, follow-up was obtained in the form of an opioid medication pill count and postoperative administration of PROs. Mean number of opioid tablets utilized by patients were calculated and compared between groups. Mean PRO scores were also compared between groups. RESULTS Eighty-two subjects were enrolled in the study. Seventy-six (38 ACT, 38 controls) completed the study. No differences between groups in demographic factors were identified. The intervention group utilized an average of 26.1±21.4 opioid tablets while the control group utilized 41.1±22.0 tablets, resulting in 36.5% less tablets utilized by subjects receiving the mobile phone-based ACT intervention (P= .004). Intervention group subjects reported a lower postoperative PROMIS Pain Intensity score of 45.9±7.2 compared to the control group’s 49.7±8.8 (P= .04). CONCLUSIONS In this study the delivery of an ACT-based intervention via an automated mobile messaging robot in the acute postoperative period decreased opioid utilization in selected orthopaedic trauma patients. Subjects receiving the ACT-based intervention also reported lower pain intensity after two weeks, though this may not represent a clinically important difference. CLINICALTRIAL ClinicalTrials.gov registry number: NCT03991546.

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