An Evaluation of Patient Characteristics Associated With Medical Disposition in the Surgical Treatment of Ankle Fractures

Meyr, Andrew J.; Dougherty, Matthew; Kwaadu, Kwasi Y.

doi:10.1053/j.jfas.2021.06.009

Cited by 5 publications

(2 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Decisions regarding time to operation depend on a variety of factors. Elements such as age, body mass index (BMI), American Society of Anesthesiologists (ASA) class, diabetes, and hypertension (HTN) have been shown to be independently associated with admission from the emergency department (ED) and inpatient repair of ankle fractures [ 6 ]. Conversely, if a patient has few medical conditions, surgeons may opt to perform the repair as an outpatient to give time for soft tissue swelling to decrease.…”

Section: Introductionmentioning

confidence: 99%

Inpatient or Outpatient: Does Initial Disposition Affect Outcomes in Trimalleolar Ankle Fractures?

Baxter,

Johnson,

Brennan

et al. 2024

Cureus

View full text Add to dashboard Cite

BackgroundThe repair of trimalleolar fractures can be challenging for surgeons and may be managed as an inpatient or an outpatient. However, it is often unclear whether these patients should be admitted immediately or sent home from the emergency department (ED). This study aims to evaluate trimalleolar fractures treated surgically in the inpatient or outpatient settings to evaluate differences in outcomes for these patients. MethodsA retrospective chart review of 223 patients undergoing open reduction internal fixation of a trimalleolar ankle fracture was performed from January 2015 to August 2022. Patients were classified by whether the fixation was performed as an inpatient or outpatient. Outcomes of interest included time from injury to surgery, complications, ED returns, and readmissions within 90 days. ResultsInpatients had significantly higher ASA scores, BMI, and rates of comorbidities. Inpatient treatment was associated with faster time to surgery (median 2.0 vs. 9.0 days) and fewer delayed surgeries more than seven days from injury (18.4 vs. 67.9%). There were no differences in complications, 90-day ED returns, readmissions, or reoperation between groups. ConclusionsInpatient admission of patients presenting with trimalleolar ankle fractures resulted in faster time to surgery and fewer surgical delays than outpatient surgery. Despite having more preoperative risk factors, inpatients experienced similar postoperative outcomes as patients discharged home to return for outpatient surgery. Less restrictive admission criteria may improve the patient experience by providing more patients with support and pain control in the hospital setting while decreasing the time to surgery.

show abstract

Section: Introductionmentioning

confidence: 99%

Inpatient or Outpatient: Does Initial Disposition Affect Outcomes in Trimalleolar Ankle Fractures?

Baxter,

Johnson,

Brennan

et al. 2024

Cureus

View full text Add to dashboard Cite

show abstract

“…Despite advances in antimicrobial therapy and intensive care techniques, the incidence of sepsis continues to rise, attributed to the aging population and the increasing prevalence of antibiotic-resistant pathogens [ 2 , 4 , 5 ]. The complexity of sepsis arises from its heterogeneity, with diverse clinical manifestations ranging from systemic inflammatory response to severe septic shock and multiple organ dysfunction syndrome [ 6 , 7 ]. Dysregulation of immune responses plays a central role in the pathophysiology of sepsis, and peripheral blood mononuclear cells (PBMCs) play a key role in this process [ 8 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

Plac8-ERK pathway modulation of monocyte function in sepsis

Zhang,

Fu,

Chen

et al. 2024

Cell Death Discov.

View full text Add to dashboard Cite

Sepsis, a life-threatening condition caused by infection, is characterized by the dysregulation of immune responses and activation of monocytes. Plac8, a protein, has been implicated in various inflammatory conditions. This study aimed to investigate the effect of Plac8 upregulation on monocyte proliferation and activation in sepsis patients. Peripheral blood samples were collected from healthy individuals and sepsis patients. Monocytes were stimulated with lipopolysaccharide (LPS) to create an in vitro sepsis model, while a murine sepsis model was established using cecal ligation and puncture (CLP). The levels of monocyte markers, proliferation index (PI), and pro-inflammatory cytokines were assessed using flow cytometry and qPCR, respectively. Plac8 and phosphorylated ERK protein levels were determined by western blot, and TNF-α, IL-6, and IL-10 levels were quantified using ELISA. The CCK-8 assay was used to evaluate PBMC proliferation and activation. The results showed that Plac8 was highly expressed in sepsis models, promoting the survival, proliferation, and activation of monocytes. Plac8 upregulation activated the ERK pathway, leading to increased phosphorylation of ERK protein and elevated levels of CD14, CD16, TNF-α, IL-6, Plac8, and IL-10. In sepsis mice, Plac8 overexpression similarly activated the ERK pathway and promoted the survival, proliferation, and activation of monocytes. In conclusion, the upregulation of Plac8 enhances the activation of the ERK pathway and promotes monocyte proliferation and activation in sepsis patients.

show abstract