Health-Care Utilization and Expenditures Associated with Long-Term Treatment After Combat and Non-Combat-Related Orthopaedic Trauma

Hering, Kalei; Fisher, Miles W A; Dalton, Michael K.; Simpson, Andrew K.; Ye, Jamie; Suneja, Nishant; Cooper, Zara; Koehlmoos, Tracey Pérez; Schoenfeld, Andrew J.

doi:10.2106/jbjs.21.01124

Cited by 6 publications

(1 citation statement)

References 22 publications

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“…Open fractures occur when the broken bone is exposed to contaminations due to skin breach, significantly increasing complications ( Louie, 2009 ). Open fractures often accompany severe bone defect, the reconstruction of segmental bone defects remains a challenge for surgeons, especially in cases of high energy injuries characterized by a high proportion of multi-tissue and infected defects ( Murray et al, 2008 ; Mathieu et al, 2011 ; Hering et al, 2022 ; Mathieu et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Combined computational analysis and cytology show limited depth osteogenic effect on bone defects in negative pressure wound therapy

Huang

Zheng²,

Dai³

et al. 2023

Front. Bioeng. Biotechnol.

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Background: The treatment of bone defects remains a clinical challenge. The effect of negative pressure wound therapy (NPWT) on osteogenesis in bone defects has been recognized; however, bone marrow fluid dynamics under negative pressure (NP) remain unknown. In this study, we aimed to examine the marrow fluid mechanics within trabeculae by computational fluid dynamics (CFD), and to verify osteogenic gene expression, osteogenic differentiation to investigate the osteogenic depth under NP.Methods: The human femoral head is scanned using micro-CT to segment the volume of interest (VOI) trabeculae. The VOI trabeculae CFD model simulating the bone marrow cavity is developed by combining the Hypermesh and ANSYS software. The effect of trabecular anisotropy is investigated, and bone regeneration effects are simulated under NP scales of −80, −120, −160, and −200 mmHg. The working distance (WD) is proposed to describe the suction depth of the NP. Finally, gene sequence analysis, cytological experiments including bone mesenchymal stem cells (BMSCs) proliferation and osteogenic differentiation are conducted after the BMSCs are cultured under the same NP scale.Results: The pressure, shear stress on trabeculae, and marrow fluid velocity decrease exponentially with an increase in WD. The hydromechanics of fluid at any WD inside the marrow cavity can be theoretically quantified. The NP scale significantly affects the fluid properties, especially those fluid close to the NP source; however, the effect of the NP scale become marginal as WD deepens. Anisotropy of trabecular structure coupled with the anisotropic hydrodynamic behavior of bone marrow; An NP of −120 mmHg demonstrates the majority of bone formation-related genes, as well as the most effective proliferation and osteogenic differentiation of BMSCs compared to the other NP scales.Conclusion: An NP of −120 mmHg may have the optimal activated ability to promote osteogenesis, but the effective WD may be limited to a certain depth. These findings help improve the understanding of fluid mechanisms behind NPWT in treating bone defects.

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Section: Introductionmentioning

confidence: 99%

Combined computational analysis and cytology show limited depth osteogenic effect on bone defects in negative pressure wound therapy

Huang

Zheng²,

Dai³

et al. 2023

Front. Bioeng. Biotechnol.

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Healthcare Utilization Following Hemipelvectomy or Hip Disarticulation in the Military Health System

Wido,

Harrington,

Schulz

et al. 2023

Military Medicine

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Introduction Amputations at the hip and pelvic level are often performed secondary to high-energy trauma or pelvic neoplasms and are frequently associated with a prolonged postoperative rehabilitation course that involves a multitude of health care providers. The purpose of this study was to examine the health care utilization of patients with hip- and pelvic-level amputations that received care in the U.S. Military Health System. Materials and Methods We performed a retrospective review of all patients who underwent a hip- or pelvic-level amputation in the Military Health System between 2001 and 2017. We compiled and reviewed all inpatient and outpatient encounters during three time points: (1) 3 months pre-amputation to 1 day pre-amputation, (2) the day of amputation through 12 months post-amputation, and (3) 13-24 months post-amputation. Health care utilization was defined as the average number of encounter days/admissions for each patient. Concomitant diagnoses following amputation including post-traumatic stress disorder, traumatic brain injury, anxiety, depression, and chronic pain were also recorded. Results A total of 106 individuals with hip- and pelvic-level amputations were analyzed (69 unilateral hip disarticulation, 6 bilateral hip disarticulations, 27 unilateral hemipelvectomy, 2 bilateral hemipelvectomies, and 2 patients with a hemipelvectomy and contralateral hip disarticulation). Combat trauma contributed to 61.3% (n = 65) of all amputations. During the time period of 3 months pre-amputation, patients had an average of 3.8 encounter days. Following amputation, health care utilization increased in both the year following amputation and the time period of 13-24 months post-amputation, averaging 170.8 and 77.4 encounter days, respectively. Patients with trauma-related amputations averaged more total encounter days compared to patients with disease-related amputations in the time period of 12 months following amputation (203.8 vs.106.7, P < .001) and the time period of 13-24 months post-amputation (92.0 vs. 49.0, P = .005). PTSD (P = .02) and traumatic brain injuries (P < .001) were more common following combat-related amputations. Conclusions This study highlights the increased health care resource demand following hip- and pelvic-level amputations in a military population, particularly for those patients who sustained combat-related trauma. Additionally, patients with combat-related amputations had significantly higher rates of concomitant PTSD and traumatic brain injury. Understanding the extensive needs of this unique patient population helps inform providers and policymakers on the requirements for providing high-quality care to combat casualties.

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Effects of Gynecomastia Surgery on Readiness and Return to Duty in an Active Duty Military Population

Zhang,

Podszus,

Williams

et al. 2023

Military Medicine

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Introduction Simple mastectomies are routinely performed in the military health care system as gynecomastia can cause significant pain and discomfort when wearing body armor. Postoperative recovery negatively impacts personnel readiness. In this study, we sought to study time to return to duty in active duty service members who undergo surgery for gynecomastia. Methods and Materials We conducted a single-center retrospective review of active duty patients undergoing a surgical operation for gynecomastia from July 2020—June 2022. A total of 96 patients were included. Our primary outcome of interest was time from surgery to return to duty. A multivariate analysis was performed to assess for factors independently associated with surgical complications including patient demographics and operative techniques. Results The median number of days to return to duty after surgery was 28 days (IQR 13-37). The median loss of duty days because of gynecomastia without surgery was 19 days (IQR 10-21), which was different on the Mann–Whitney U test. Surgical complications were observed in 19 patients (19.7%) with the most common complications being seroma (11), hematoma (4), nipple-areolar complex necrosis (2), and infection (2). Patients with a complication have significantly more time to return to duty (28 vs. 49 days, P < .001). Risk factors associated with an increased risk of complication include ranks E1-E4, behavioral health diagnosis, “open” vs. “combined” technique with liposuction, length of operation greater than 58 minutes, and excised breast mass greater than 17.9 g. Conclusions Gynecomastia surgery is associated with a detriment to personnel readiness. Surgery should be reserved for patients with severe symptoms that prevent the performance of daily duties. Furthermore, factors associated with an increased risk for complications include ranks E1-E5, behavioral health diagnosis, length of operation >58 minutes, and excised breast mass >17.9 g. The operating surgeon should be mindful of these factors.

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Health-Care Utilization and Expenditures Associated with Long-Term Treatment After Combat and Non-Combat-Related Orthopaedic Trauma

Cited by 6 publications

References 22 publications

Combined computational analysis and cytology show limited depth osteogenic effect on bone defects in negative pressure wound therapy

Combined computational analysis and cytology show limited depth osteogenic effect on bone defects in negative pressure wound therapy

Healthcare Utilization Following Hemipelvectomy or Hip Disarticulation in the Military Health System

Effects of Gynecomastia Surgery on Readiness and Return to Duty in an Active Duty Military Population

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