Abstract:
OBJECTIVES:Hospitals and providers that accept transfer patients risk lower ratings on publically reported quality measures that are inadequately adjusted for infirmity and complexity. We compared the outcomes of transferred patients and nontransferred patients after treatment of a hip fracture and sought to determine if expected outcomes based on an expansion of All Patient Refined-Diagnosis Related Groups (APR-DRGs) norms are accurately adjusted for transfer status. DESIGN:Retrospective cohort study. SETTING:Tertiary care referral center. PATIENTS:Four hundred six consecutive patients 65 years and older who received operative treatment of an acute hip fracture. INTERVENTION:Patients who were transferred from another acute care hospital or a skilled nursing facility before treatment were classified as transfer patients (n = 123), and all other patients were nontransfer patients (n = 283). MAIN OUTCOME:Groups were compared with respect to in-hospital mortality, length of stay (LOS), excess days over the geometric mean length of stay (GMLOS), and readmission rate as well as expected length of stay (Exp LOS) and expected mortality (Exp Mort) based on APR-DRG norms and additional adjustment for transfer status. RESULTS:Transfer patients had significantly greater LOS (10.2 vs 9.6 days; P < 0.05), Exp LOS (9.7 vs 7.7 days; P < 0.001), Exp Mort (0.07 vs 0.03; P = 0.004), and excess days over the GMLOS (4.1 vs 3.3 days; P = 0.025) than nontransfer patients, near-significant greater in-hospital mortality (9.8 vs 4.9%; P = 0.069), and similar readmission rates. The differences in LOS and Exp LOS were nonsignificant in both transfer (P = 0.49) and nontransfer patients (P = 0.10). CONCLUSIONS:Patients 65 years and older transferred to a tertiary care facility for treatment of an acute hip fracture have worse outcome than nontransfer patients. Unadjusted data such as in-hospital mortality may be misleading, but risk adjustment using the APR-DRG methodology and additional correction for transfer status may provide meaningful benchmarks.
journal_name
J Orthop Traumajournal_title
Journal of orthopaedic traumaauthors
Wiggers JK,Guitton TG,Smith RM,Vrahas MS,Ring Ddoi
10.1097/BOT.0b013e31821146b1subject
Has Abstractpub_date
2011-11-01 00:00:00pages
666-9issue
11eissn
0890-5339issn
1531-2291journal_volume
25pub_type
杂志文章abstract:OBJECTIVES:To determine whether surgeons' and patients' perceptions of outcomes after high-energy lower-extremity trauma are similar and to identify factors associated with disagreement. DESIGN:Prospective study. SETTING:Eight level 1 trauma centers. PATIENTS:Four hundred sixty-three patients treated for limb-threat...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,多中心研究
doi:10.1097/BOT.0b013e3181ab2c90
更新日期:2009-11-01 00:00:00
abstract:PURPOSE:There are an estimated 1.2 million deaths from road traffic injuries annually, disproportionately affecting patients in low-resource settings. The purpose of this scoping review is to identify knowledge gaps in global orthopaedic trauma in an effort to help prioritize future research. METHODS:Using the 6-stage...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/BOT.0000000000001293
更新日期:2018-10-01 00:00:00
abstract:PURPOSE:The purpose of this OTA-approved pilot study was to compare the clinical and functional outcomes of the knee joint after infrapatellar (IP) versus suprapatellar (SP) tibial nail insertion. DESIGN:Prospective, randomized. SETTING:Level I trauma center. METHODS:After institutional review board approval, skelet...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,随机对照试验
doi:10.1097/BOT.0000000000000499
更新日期:2016-03-01 00:00:00
abstract::Periprosthetic humerus fractures are relatively uncommon occurrence that can be difficult to manage nonoperatively. Locking plate technology has enhanced the surgical management of these fractures. However, adequate fixation around the stem remains of some concern. We describe an osteosynthesis technique using a locki...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000646
更新日期:2016-11-01 00:00:00
abstract:OBJECTIVES:To develop an accurate machine learning (ML) predictive model incorporating patient, fracture, and trauma characteristics to identify individual patients at risk of an (occult) PMF. METHODS:Databases of 2 studies including patients with TSFs from 2 Level 1 trauma centers were combined for analysis. Using te...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001663
更新日期:2020-03-01 00:00:00
abstract::Percutaneous iliosacral screw (IS) fixation for pelvic ring injuries with the use of an O-arm imaging system has been associated with decreased procedure time and improved accuracy of IS screw placement compared with the use of fluoroscopic guidance. Specifically, patients with sacral dysmorphism require identificatio...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001213
更新日期:2018-08-01 00:00:00
abstract:OBJECTIVES:This study was designed to investigate the relationship between upper extremity (UE) injuries and occupant restraint systems among front seat occupants who were involved in frontal motor vehicle collisions (MVCs). DESIGN:Case-control. SETTING:The 1995 through 2002 National Automotive Sampling System (NASS)...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/01.bot.0000161543.52643.ab
更新日期:2005-09-01 00:00:00
abstract:OBJECTIVES:Improved patient outcomes after plating of displaced clavicle fractures have been demonstrated by recent clinical studies. Many of these patients, however, complain of anterior chest wall numbness after this procedure; we hypothesize that numbness likely persists long term for many patients, but without effe...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000095
更新日期:2014-11-01 00:00:00
abstract::Recent studies on ankle syndesmosis injuries have shown that a significant amount of rotational malediction of the distal fibula are missed and may lead to poor functional outcome. A new set of radiographic criteria were developed to help detect distal fibula internal and external rotation using conventional fluorosco...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e31828f89a9
更新日期:2013-12-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to report the clinical results of atypical femoral fractures (AFFs) treated with low-intensity pulsed ultrasound (LIPUS). MATERIALS AND METHODS:The data on AFFs that were surgically treated in our hospital from 2010 to 2016 was retrospectively analyzed. AFF was diagnosed based on th...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/01.bot.0000520889.69599.f3
更新日期:2017-07-01 00:00:00
abstract::Patella fractures are challenging orthopaedic injuries. Many commonly used fixation techniques can be ineffective and lead to poor clinical outcomes even with satisfactory reductions and fracture healing. In this investigation, we present the technique of cage plate fixation of patella fractures and the clinical outco...
journal_title:Journal of orthopaedic trauma
pub_type: 临床试验,杂志文章
doi:10.1097/BOT.0000000000000415
更新日期:2015-12-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to evaluate the loss of strength in the distal humerus that resulted from the creation of two different entry portals used for retrograde humeral nailing. DESIGN:Nine pairs, treated as blocks of size two, of fresh frozen humeri from individuals free of musculoskeletal disease w...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200002000-00005
更新日期:2000-02-01 00:00:00
abstract::A rare case of a complete fracture-separation of the proximal radial epiphysis is described in a pediatric patient. A further complicating factor is the delay in diagnosis that may worsen prognosis. An emphasis on early detection by physical examination and imaging studies, as well as consideration of treatment option...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/00005131-199506000-00013
更新日期:1995-06-01 00:00:00
abstract:OBJECTIVES:(1) To demonstrate that a validated trauma triage score for middle-aged and geriatric patients could identify those at high risk of mortality within the first 2 days of hospitalization and (2) determine the cost of care for this cohort of patients. DESIGN:Prospective cohort study. SETTING:Single level 1 tr...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001187
更新日期:2018-07-01 00:00:00
abstract::Femoral neck nonunions are a difficult complication in the treatment of femoral neck fractures and have traditionally been managed using an intertrochanteric valgus osteotomy and blade plate. We propose an alternative method, a proximal femoral valgus osteotomy using a sliding hip screw instead of a blade plate. This ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/00005131-200608000-00006
更新日期:2006-07-01 00:00:00
abstract:OBJECTIVES:To compare the abductor muscle function and trochanteric tenderness in patients operated with hemiarthroplasty using the direct lateral (DL) or posterolateral (PL) approach for displaced femoral neck fracture. DESIGN:Prospective cohort study. SETTING:A secondary teaching hospital. PARTICIPANTS:We enrolled...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000532
更新日期:2016-06-01 00:00:00
abstract:OBJECTIVES:To determine the association of preinjury opioid use on incidence of fasciotomy after lower extremity trauma. DESIGN:Retrospective case-control study. SETTING:Level 1 trauma center. PATIENTS/PARTICIPANTS:We identified 245 consecutive patients treated with fasciotomy for compartment syndrome of the lower e...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001650
更新日期:2020-03-01 00:00:00
abstract::Prospectively, 40 patients with an average age of 45 (20-65) with closed transverse fractures of the middle one-third of the humerus without associated radial nerve palsy were treated. All had failed nonoperative reduction and were then operated on with either compression plating or intramedullary fixation with Hacket...
journal_title:Journal of orthopaedic trauma
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00005131-199506000-00003
更新日期:1995-06-01 00:00:00
abstract:OBJECTIVES:To describe the technique and to determine the outcome of operatively treated displaced scapular body or glenoid neck fractures using minifragment fixation through a modified Judet approach. DESIGN:Retrospective review of scapular or glenoid fractures. SETTING:Level 1 teaching trauma center. PATIENTS:All ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e3181a18216
更新日期:2009-09-01 00:00:00
abstract::We reviewed the treatment and results of 22 Bennett's fractures. Of these fractures, treated by closed reduction and plaster immobilization, 20 were available for follow-up. Eighteen patients had a subjectively satisfactory outcome, and seven had a radiographically confirmed arthrosis of the first carpometacarpal join...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199502000-00004
更新日期:1995-02-01 00:00:00
abstract::Tubular poly(L-lactide) membranes with a pore size of 5-15 microns and a molecular weight of 70,000 Daltons were implanted into 24 New Zealand skeletally mature rabbits to cover 10-mm mid-diaphyseal defects of the radius of the forelimb. An identical defect on the contralateral limb was not treated with the membrane a...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199604000-00006
更新日期:1996-01-01 00:00:00
abstract::To evaluate the biomechanical and clinical results of modified separate vertical wiring technique (SVW) for inferior pole patellar fracture repair we conducted a finite element biomechanical study using 2 fixation methods and evaluated a clinical series of eleven patients. The modified SVW technique was an effective, ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001080
更新日期:2018-04-01 00:00:00
abstract::Long-bone deformity may be significantly symptomatic. A uniplanar corrective osteotomy uses a single cut to correct coronal, sagittal, and axial plane deformity simultaneously. Careful preoperative planning is required in addition to a comprehensive understanding of the magnitude and plane of the true deformity of the...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001519
更新日期:2019-08-01 00:00:00
abstract:OBJECTIVE:Evaluate the ability of osteogenic protein-1 to induce formation of de novo bone in the presence of bacterial infection and metal in an intramuscular osteoinduction model in the rat. DESIGN:Prospective experimental design with assessment time points of up to 4 weeks. SETTING:Intramuscular pocket surgically ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200408000-00008
更新日期:2004-08-01 00:00:00
abstract:OBJECTIVE:To analyze the mechanical stability of locked plating in comparison with tension-band wiring for the fixation of fractures of the patella. METHODS:Biomechanical tests were performed on artificial foam patella specimens comparing an angular stable plate and monocortical screws with tension-band wiring. Tests ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000309
更新日期:2015-09-01 00:00:00
abstract:OBJECTIVES:To compare the risks of surgical site infection (SSI) and postoperative complications after acetabular fracture open reduction internal fixation (ORIF) in patients receiving topical intrawound antibiotic powder compared to those not receiving antibiotic powder (control group). DESIGN:Retrospective cohort SE...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001943
更新日期:2020-09-02 00:00:00
abstract::A 14 cm deficit of the tibia with a soft tissue deficit was resolved using the apparatus of Ilizarov. The apparatus was applied using a double corticotomy of the proximal and distal remainder of the tibia. The fragments were moved until they met each other in the central part of the deficit. Afterwards, a part of the ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:
更新日期:1990-01-01 00:00:00
abstract:OBJECTIVE:This study was designed to investigate the specific type and incidence of implant failure in patients with a proximal femur fracture treated with a proximal femoral nail antirotation. This device has a helical-shaped blade as a neck-head holding device, instead of the lag screw used in other intramedullary na...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e31822c53c1
更新日期:2012-08-01 00:00:00
abstract::Autologous bone graft is usually necessary for reconstruction of nonunions with shortening or bone loss. We developed a new technique to reconstruct such nonunions or delayed unions without bone grafting by chipping and lengthening of bone at the original fracture site. Five in six nonunions with shortening or bone lo...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e318041f6d1
更新日期:2007-07-01 00:00:00
abstract::The conventional qualitative techniques of manual manipulation and plain radiography do not give a quantifiable measurement of healing. With internal fixation, manual manipulation is not usually possible, and conventional radiographs may not give much useful information, particularly if only a small amount of callus i...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199611000-00010
更新日期:1996-01-01 00:00:00