Background The Covid-19 pandemic threatens to overwhelm scarce clinical resources. Risk factors for severe illness must be identified to make efficient resource allocations.

Background: In January 2020, The Centers for Medicare and Medicaid Services approved total knee arthroplasty (TKA) to be performed in ambulatory surgery centers (ASCs). This study aims to develop a predictive model for targeting appropriate patients for ASC-based TKA. Methods: A retrospective review of 2266 patients (205 same-day discharge [SDD; 9.0%] and 2061 oneday length of stay [91.0%]) undergoing TKA at a regional medical center between July 2016 and September 2020 was conducted. Multiple logistic regression was used to evaluate predictors of SDD, as these patients represent those most likely to safely undergo TKA in an ASC. Results: Controlling for other demographics and comorbidities, patients with the following characteristics were at reduced odds of SDD: increased age (odds ratio [OR] ¼ 0.935, P < .001), body mass index !35 (OR ¼ 0.491, P ¼ .002), female (OR ¼ 0.535, P < .001), nonwhite race (OR ¼ 0.456, P ¼ .003), primary hypertension (OR ¼ 0.710, P ¼ .032), !3 comorbidities (OR ¼ 0.507, P ¼ .002), American Society of Anesthesiologists score !3 (OR ¼ 0.378, P < .001). The model was deemed to be of adequate fit using the Hosmer and Lemeshow test (c 2 ¼ 12.437, P ¼ .112), and the area under the curve was found to be 0.773 indicating acceptable discrimination. Conclusion: For patients undergoing primary TKA, increased age, body mass index !35, female gender, nonwhite race, primary hypertension, !3 comorbidities, and American Society of Anesthesiologists score !3 decrease the likelihood of SDD. A predictive model based on readily available patient presentation and comorbidity characteristics may aid surgeons in identifying patients that are candidates for SDD or ASC-based TKA.

High quality comprehensive care for SCD can be delivered for a low income, aboriginal population in India through a community driven network of care. This model can serve as a template for healthcare delivery for SCD in low-income communities.

Objective Endovascular aortic repair (EVAR) is considered a lower risk option for treating abdominal aortic aneurysms (AAA), and is of particular utility in patients with poor functional status who may be poor candidates for open repair. However, the specific contribution of preoperative functional status EVAR outcomes remains poorly defined. We hypothesized that impaired functional status, based simply on the ability of patients to perform activities of daily living, is associated with worse outcomes after EVAR. Methods Patients undergoing non-emergent EVAR for AAA between 2010 and 2014 were identified in the National Surgical Quality Improvement Program (NSQIP) database. The primary outcomes were 30-day mortality and major operative and systemic complications. Secondary outcomes were inpatient length of stay, need for reoperation, and discharge disposition. Using NSQIP defined preoperative functional status, patients were stratified as Independent or Dependent (either partial or totally dependent), and compared by univariate and multivariable analyses. Results Of 13,432 patients undergoing EVAR between 2010 – 2014, 13,043 were independent (97%) and 389 were dependent (3%) prior to surgery. Dependent patients were older and more frequently minorities; had higher rates of chronic pulmonary, heart, and kidney disease; and were more likely to have an American Society of Anesthesiologists score of 4 or 5. On multivariable analysis, preoperative dependent status was an independently risk factor for operative complications (OR 3.1, 95% CI 2.5 – 3.9), systemic complications (2.8, 2.0 – 3.9), and 30-day mortality (3.4, 2.1 – 5.6). Secondary outcomes were worse among dependent patients. Conclusions Although EVAR is a minimally invasive procedure with substantially less physiologic stress than open aortic repair, preoperative functional status is a critical determinant of adverse outcomes after EVAR, in spite of the minimally invasive nature of the procedure. Functional status, as measured by performance of activities of daily living, can be used as a valuable marker of increased perioperative risk, and may identify patients who may benefit from preoperative conditioning and specialized perioperative care.

Study Design: Observational cohort study. Objective: To compare 1-year perioperative complications between structural allograft (SA) and synthetic cage (SC) for anterior cervical discectomy and fusion (ACDF) using a national database. Methods: The TriNetX Research Network was retrospectively queried. Patients undergoing initial single or multilevel ACDF surgery between October 1, 2015 and April 30, 2019 were propensity score matched based on age and comorbidities. The rates of 1-year revision ACDF surgery and reported diagnoses of pseudoarthrosis, surgical site infection (SSI), and dysphagia were compared between structural allograft and synthetic cage techniques. Results: A comparison of 1-year outcomes between propensity score matched cohorts was conducted on 3056 patients undergoing single-level ACDF and 3510 patients undergoing multilevel ACDF. In single-level ACDF patients, there was no difference in 1-year revision ACDF surgery ( P = .573), reported diagnoses of pseudoarthrosis ( P = .413), SSI ( P = .620), or dysphagia ( P = .529) between SA and SC groups. In multilevel ACDF patients, there was a higher rate of revision surgery (SA 3.8% vs SC 7.3%, odds ratio = 1.982, P < .001) in the SC group, and a higher rate of dysphagia in the SA group (SA 15.9% vs SC 12.9%). Conclusion: While the overall revision and complication rate for single-level ACDF remains low despite interbody graft selection, SC implant selection may result in higher rates of revision surgery in multilevel procedures despite yielding lower rates of dysphagia. Further prospective study is warranted.