No abstract

Musculoskeletal injuries comprise a large percentage of hospital admissions for adults and often contribute to persistent daily pain as an illness; opioid dependence; disability; and complaints of increased depression, anxiety, and symptoms of post-traumatic stress disorder. The prevalence of depression and post-traumatic stress disorder after orthopaedic trauma has been found to be considerably greater than the general adult cohort. Soon after sustaining a fracture, psychological factors can predict pain and disability many months after injury, even after controlling for injury severity. Thus, early in the care of orthopaedic trauma, there exists an opportunity to improve overall health by attending to psychological and social concerns, along with physical health. Recent literature has identified clinically actionable subgroups within the orthopaedic trauma cohort that are at psychological risk after an injury. Improving positive factors such as resilience, social support, and self-efficacy via validated interventions such as Cognitive-Behavioral Therapy, mindfulness training, and other types of mindset training has helped people return to their daily routine. Raising awareness of the psychological effects of trauma among the orthopaedic community could improve post-treatment planning, increase referrals to appropriate nonmedical professionals, and implement earlier effective interventions.

No abstract

Introduction:From 2000 to 2010, the cohort of patients aged 85 to 94 years had the fastest growth rate increasing in size by approximately 30%. The need for total knee arthroplasty (TKA) continues to increase with a larger percentage of patients older than 80 years requiring TKA. The purpose of our study was to examine the rate and risks of 30-day complications and unplanned readmission in patients older than 80 years.Materials and Methods:The National Surgical Quality Improvement Project database for the years 2008 to 2014 was queried for patients older than 80 years undergoing TKA. The risks of major complications, minor complications, bleeding occurrences, unplanned readmissions, and deaths over a 30-day period were examined using univariate and multivariate analyses.Results:Overall, 12 026 patients were included for analysis. In all, 422 (3.5%) experienced a major complication, 2316 (19.3%) experienced a minor complication, 2074 (17.2%) had a bleeding occurrence requiring transfusion, and 566 (4.7%) experienced an unplanned readmission. Thirty-eight (0.3%) deaths were recorded. There were no significant risk factors for major complications. Patients with an American Society of Anesthesiologists (ASA) >2 (odds ratio [OR]: 1.43 [1.239-1.651]), patients older than 84 years (OR: 1.240 [1.072-1.434]), and patients receiving general anesthesia (OR: 1.191 [1.035-1.370]) had increased risks of minor complications. Patients with a body mass index >30 (OR: 0.640 [0.532-0.770]) and men (OR: 0.815 [0.706-0.941]) had reduced rates of minor complications. Increased risk of unplanned readmission occurred in patients with chronic obstructive pulmonary disease (OR: 1.694 [1.007-2.850]) and congestive heart failure (OR: 3.030 [1.121-8.192]). Increased risk of death was seen in patients with an ASA >2 (OR: 8.9 [1.144-69.82]).Discussion/Conclusion:Elderly patients undergoing TKA have high complication and readmission rates. Surgeons should convey these increased risk factors and rates of complications in elective TKAs to their elderly patients and work with primary care physicians to mitigate these risks.