Background: Faculty promotion and research productivity are important for the overall career trajectory of academic orthopaedic surgeons. The purpose of this study was to investigate the role that subspecialty and demographic factors play in research productivity and academic advancement among orthopaedic surgeons. Methods: We conducted a retrospective cross-sectional analysis of academic rank among orthopaedic surgeons in 2018. We identified academic orthopaedic programs in the United States from the Fellowship and Residency Electronic Interactive Database (FREIDA) and collected publicly available data for surgeons, including fellowship training, gender, faculty rank, geographic region, and years since residency, from institutional websites. Research productivity was defined with the Hirsch index (h-index) from Scopus, and the m-index was calculated from the surgeon's h-index and the date of the first publication. Multivariate regression analyses were performed to determine the variables that are associated with associate professorship, full professorship, and the h-index. Results: In this study, we identified and included 2,879 academic orthopaedic surgeons. Completion of a fellowship in foot and ankle (odds ratio [95% confidence interval]: 2.45 [1.17 to 5.15]), sports medicine (2.15 [1.12 to 4.15]), trauma (2.83 [1.42 to 5.66]), hand and upper extremity (2.20 [1.13 to 4.28]), musculoskeletal oncology (3.28 [1.49 to 7.21]), or upper-extremity reconstruction (3.20 [1.31 to 7.81]) was associated with associate professorship. Completion of a trauma fellowship was associated with full professorship (2.93 [1.27 to 6.77]). Completion of a fellowship in adult reconstruction (difference in least-squares means [95% confidence interval]: 5.01 [1.22 to 8.81]), sports medicine (4.52 [1.00 to 8.04]), spine (5.40 [1.63 to 9.18]), or upper-extremity reconstruction (10.64 [6.15 to 15.12]) or the completion of multiple fellowships (5.12 [1.27 to 8.94]) were independently associated with a higher h-index. Women had significantly lower h-indices than men at the assistant (median [interquartile range]: 3 [1 to 6] versus 4 [2 to 8]) and full professor (17 [12 to 26] versus 22 [13 to 34]) levels. There were no differences in the m-index between men and women at any academic rank. Conclusions: Orthopaedic subspecialty selection is independently associated with research productivity and academic rank. The differences in research productivity may be important to consider when evaluating orthopaedic surgeons for promotion. While female surgeons had lower h-indices than their male counterparts, this difference was not seen when using the m-index.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G790).
Background: To investigate the association between American Society of Anesthesiologists (ASA) physical status classification and rates of postoperative complications in patients undergoing facial fracture repair. Methods: Patients were divided into 2 cohorts based on the ASA classification system: Class I/II and Class III/IV. Chi-square and Fisher’s exact tests were used for univariate analyses. Multivariate logistic regressions were used to assess the independent associations of covariates on postoperative complication rates. Results: A total of 3575 patients who underwent facial fracture repair with known ASA classification were identified. Class III/IV patients had higher rates of deep surgical site infection ( P = .012) as well as bleeding, readmission, reoperation, surgical, medical, and overall postoperative complications ( P < .001). Multivariate regression analysis found that Class III/IV was significantly associated with increased length of stay ( P < .001) and risk of overall complications ( P = .032). Specifically, ASA Class III/IV was associated with increased rates of deep surgical site infection ( P = .049), postoperative bleeding ( P = .036), and failure to wean off ventilator ( P = .027). Conclusions: Higher ASA class is associated with increased length of hospital stay and odds of deep surgical site infection, bleeding, and failure to wean off of ventilator following facial fracture repair. Surgeons should be aware of the increased risk for postoperative complications when performing facial fracture repair in patients with high ASA classification.
Objective This study aims to provide an age-stratified analysis of associations with patient sex in pediatric inpatients with acute rhinosinusitis (ARS). Study Design Retrospective cohort study. Setting National administrative database. Methods The 2016 Kids’ Inpatient Database was queried for pediatric inpatients (<21 years old) with ARS ( ICD-10 J01). Orbital and intracranial sequelae were selected via ICD-10 codes. Statistical associations by sex were determined via univariate and multivariable analyses. Weighted measures are reported to provide national estimates. Results Of the 5882 patients identified with ARS, 2404 (40.9%) were female and 3478 (59.1%) were male. Male patients were younger than female patients (mean, 9.3 vs 9.9 years; P < .001). Multivariable analysis indicated that males and females had similar total charges ($71,094 vs $66,892, P = .464) and length of stay (5.8 vs 6.1 days, P = .263). However, male patients underwent more procedures (1.8 vs 1.5, P < .001). Mortality was similar between male and female patients (odds ratio [OR], 0.91; P = .664). Male patients also had increased odds for having orbital (OR, 1.58; P < .001) and intracranial (OR, 1.99; P < .001) complications. Differences in sex-dependent sequela risk were starkest in patients aged 14 to 20 years, with male patients being more likely to have orbital (OR, 2.91; P < .001) and intracranial (OR, 3.86; P < .001) complications. Conclusion In a cohort of pediatric inpatients with ARS, males have increased odds for orbital and intracranial sequelae and undergo more procedures than females. However, males and females have similar charges and length of stay. Our study highlights age-stratified differences in ARS across patient sex.
Objectives Mucosal melanoma (MM) is a rare malignancy that can present in the head and neck (H&N). The Oral cavity is the second most common primary site in the H&N after sinonasal mucosa. This study investigates the impact of demographic and clinical factors on survival in oral cavity MM. Further, it investigates the outcomes and utility of elective neck dissections (END) in the management of oral MM. Methods The National Cancer Database was used to evaluate 432 patients with oral cavity MM from 2004 to 2016. Kaplan‐Meir and Cox regression analyses were used to determine variables associated with survival. Results The mean age was 64.0 ± 16.0 years. Most patients were white (85.1%) and male (60.0%). Gingiva (37.6%) and hard palate (36.1%) were the most common primary subsites in the oral cavity. Five‐year overall survival was 31.0%. Age (Hazards Ratio [95% Confidence Interval], 1.03 [1.01–1.06]), N‐stage (1.94 [1.10–3.42]), M‐stage (10.13 [3.33–30.86]), male sex (1.79 [1.06–3.03]), and African‐American race (2.63 [1.14–6.11]) were significantly associated with worse survival. 199 patients (46.9%) underwent neck dissection including 118 with lymph node yield (LNY) ≥ 18. The rate of occult nodal positivity was 45.4% for LNY ≥ 18 and 28.3% for LNY ≥ 1. ENDs were not associated with improved outcomes. However, occult lymph node involvement was associated with worse overall survival (p = 0.004). Conclusions Oral cavity MM has a poor prognosis. Lymph node involvement, distant metastasis, age, race, and male sex are associated with worse outcomes. Performing an END did not improve survival. However, END may have a prognostic role and help select patients for treatment intensification. Level of Evidence 4 Laryngoscope, 133:317–326, 2023
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