Background/aimHealth-related quality of life (HRQoL) is increasingly assessed within orthopaedic research. For those patients presenting with glenoid labral pathologies, there is little information on how baseline comorbidities affect long-term outcomes and HRQoL. This study aimed to investigate a model, including baseline comorbidities and demographics, to predict change in 2-year HRQoL scores in adult patients with glenoid labral tears or degenerations.MethodsParticipants provided Functional Comorbidity Index (FCI) scores and self-completed the Western Ontario Rotator Cuff (WORC) index at 6, 12 and 24 months. Univariable and multivariable linear regressions were performed to assess predictive quality of baseline comorbidities and demographics on the primary outcome measure of interest (change in WORC score).ResultsMultivariate regression with a continuous scaled FCI (β=617.8, p=0.042), age (by decade) (β=297, p<0.01), surgical group (β=−476.69, p<0.01) and an interaction term between FCI and age (β=−103.65, p=0.03) were significant predictors of change in WORC scores at 2-year follow-up (r2=0.293858). Multivariate regression with FCI scaled categorically reported only patients with three comorbidities (β=−454.06, p=0.057) and age (by decade) (β=156.87, p=0.04) as the only significant predictors of change in WORC scores at 2-year follow-up (r2=0.1279).ConclusionThe continuous FCI model is better suited to predict future WORC and HRQoL scores among this patient population. Patients reporting with higher numbers of baseline comorbidities improved significantly more than patients with fewer comorbidities. This information on expected change in HRQoL scores among patients with a wide range of FCI scores at baseline may help guide treatment decisions based on these criteria.

Pulmonary embolism (PE) is a diagnosis on the broader spectrum of venous thromboembolic (VTE) disease. The diagnostic key for clinicians is detecting which patients have a "high risk" of complications or mortality and who are in the "low-risk" population. The Pulmonary Embolism Severity Index (PESI) and HESTIA scores are validated risk stratification tools to determine if patients diagnosed with PE can be successfully managed in the outpatient versus inpatient setting. We aimed to investigate the appropriateness of PE admissions to our institution based on the risk stratification recommendations from PESI and HESTIA scores.We retrospectively identified 175 patients admitted with a diagnosis of PE over one year at our hospital. Baseline demographics, length of admission, and admitting diagnoses were collected for all patients included in this study. PESI and HESTIA scores were then calculated for all included patients.The average PESI score was 91.65 (95% confidence interval: 86.33, 96.97). There were 87 patients (49.7%) that had a low or very low PESI score of fewer than 85 points. Fifty-seven patients (33.7%) presented with a HESTIA score of 0. The risk stratification score indicates these patients as low risk, and appropriate for outpatient management. However, they were instead admitted to the hospital which contributes to increased costs, risk of adverse events, etc. There were 0 mortalities reported for patients in the "low or very low risk" groups, with four reported mortalities in the "very high risk" groups.In our cohort, 33.7%-49.7% of admissions for PE were risk-stratified as "low risk" and qualified for outpatient management based on HESTIA and PESI risk stratification scores, respectively. The underutilization of validated risk scores upon initial diagnosis of PE may lead to worse outcomes and increased healthcare expenditure.

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Aortic dissection is an acute and life-threatening disease entity. Mortality rates increase every hour after the presentation. Typical treatment includes medical management of blood pressure and heart rate control followed by prompt transfer to an operating room for surgical repair. We present a case of medically managed Stanford type A aortic dissection in a postoperative coronary artery bypass graft (CABG) patient.A 77-year-old man with a past medical history of hypertension and hyperlipidemia presented after an outpatient nuclear stress test demonstrated a reversible inferior wall defect. He was subsequently referred to a cardio-thoracic surgeon and underwent coronary artery bypass graft (CABG) surgery. Three weeks later, the patient presented to the emergency department complaining of a productive cough, nausea, vomiting, and fever. He was diagnosed with sepsis secondary to pneumonia. A CT chest demonstrated a new 3.9 cm long segment of dissection in the ascending thoracic aorta. Due to postoperative recovery from recent CABG, a decision was made to treat the ascending thoracic aortic dissection (Stanford type A) medically. He was advised to continue intensive antihypertensive medications and close follow-up with a cardiologist and cardiothoracic surgeon on an outpatient basis. Subsequent follow-up CT chest angiography at one month, four months, and 12 months later did not demonstrate the progression of the ascending aortic dissection.Decisions to deviate from the usual care should best be taken in a multidisciplinary team approach. Patients should clearly be informed about the rationale behind these complex decisions.