No abstract

Incidental durotomy, younger age, and discharge to nursing facility were associated with higher risk of 90-day hospital readmission after lumbar discectomy. As compared with extensive spine procedures, patient comorbidity burden may not be as significant in predicting readmission after this relatively less invasive procedure.

Purpose To evaluate the risk of post-operative infection after intra-articular steroid injection at the time of knee arthroscopy at a single institution high-volume sports medicine practice. Methods The electronic medical record at a single institution was queried for all patients who underwent knee arthroscopy from 2011 to 2019. Patients were included if they underwent more simple arthroscopic procedures: diagnostic arthroscopy, meniscectomy, loose body removal, synovectomy, or microfracture. Patients were excluded if they underwent more complex procedures, such as ligament reconstruction, meniscus repair, or any open procedures. These patients' medical records were then queried for current procedural terminology and international classiication of disease codes indicating post-operative infection. Individual chart review was performed on this group of patients to determine if a true postoperative infection occurred within 6 months of the index arthroscopy. Patients were then categorized into "intra-operative steroid injection" versus "no steroid" based on each surgeon's preferred intra-operative analgesic injection cocktail. Results A total of 6889 patients were identiied, including 2416 (35.1%) who were given intra-articular steroid at the time of knee arthroscopy. Post-operative infection occurred in 10 patients (0.15%) at a median of 18 days (range 9-42 days), 7 who received intra-operative steroid injection (0.29%) and 3 who did not (0.067%), p = 0.040. The relative risk of infection for those who received intra-operative steroid injection was 4.32 times higher than those who did not, with a number needed to harm of 448. There were no signiicant diferences in age, body mass index, smoking status, or the prevalence of diabetes between those who got infected and those who did not. Conclusions Knee infection following arthroscopic surgery is rare. Intra-operative steroid injection during arthroscopic knee surgery is associated with a 4.3-fold increased risk of subsequent knee infection. While the overall risk remains low, the use of intra-operative steroids is expected to result in one additional knee infection for every 448 arthroscopic procedures performed. Level of evidence IV.

Fachzeitschrift zu Realität, Qualität und Innovation der Gesundheitsversorgung 04/18 11. Jahrgang "Der Nationale Aktionsplan Gesundheitskompetenz" (Schaeffer) S c h w e r p u n k t t h e m a a u f 6 S e i t e n "Kosten-und Mengeneffekte des MICADO-Selektivvertrags" (Jacob)

% of the population) and expert opinion. A global Markov model was adopted to predict the number of subsequent cardiovascular events in this population treated with aspirin in secondary prevention. Healthcare costs were based on corresponding reimbursement tariffs. Indirect costs of atherothrombotic disease were calculated based on claims from Czech Social Security Administration (CSSA) database. Results: A total number of 49,215 patients suffering from both CAD and PAD was estimated. In lifetime horizon, these patients will develop 18,766 myocardial infarctions, 7,439 strokes, 6,639 cases of extracranial and 1,525 intracranial haemorrhage, 5,311 cases of acute limb ischaemia, 4,648 amputations, 3,098 cases of venous thromboembolism and 22,292 cardiovascular deaths. From a healthcare payer perspective, all these events will be associated with a total cost of V360.7 million. According to CSSA database, CAD or PAD induce 1,946 cases of invalidity per year, corresponding to V7.4 million of invalidity pensions annually and V24.7 million loss of productivity/year. Moreover, CAD or PAD lead to 4,802 sickleaves each year, corresponding to annual productivity loss of V55.5 million. In sum, these indirect costs equal to V87.6 million per year. Conclusions: The costs associated with atherothrombotic diseases are substantial. To our knowledge, this is the first Czech study evaluating the burden of atherothrombotic diseases from societal perspective. Our estimates may support future health policy decisions concerning various prevention and intervention programs.