Browsing by Author "Kempton, Laurence"
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Item A Liberal Transfusion Strategy Leads to Higher Infection Rates, ORthopaedic Trauma and Anemia: Conservative vs. Liberal Transfusion Strategy (ORACL), a Prospective Randomized Study 30 Day Inpatient Complications(2022-09-17) Mullis, Leilani; Mullis, Brian; Virkus, Walter; Kempton, LaurencePurpose: There is ongoing debate what level of anemia should be used as a transfusion trigger for asymptomatic trauma patients no longer in a resuscitative phase immediately following trauma. A previous retrospective case-control study by one of the lead investigators showed there was a higher risk of complications with a more liberal strategy, and this appeared to be dose-dependent. Multiple previous studies have shown allogeneic blood transfusion is immunosuppressive and may increase infection rates in surgical patients. This study was completed to determine if a more conservative strategy was safe and might decrease the risk of infection. Methods: The ORACL pilot study randomized 100 patients ages 18-50 to a conservative transfusion strategy of 5.5 g/dL vs a liberal strategy of 7.0 g/dL in asymptomatic patients no longer being resuscitated who required inpatient admission for an associated musculoskeletal injury. Enrollment was performed at 3 level 1 trauma centers from 2014-2021. Ninety-nine patients completed 30 day follow up. Results: There was a significant association between a liberal transfusion strategy and higher rate of deep infection (defined as unplanned return to OR for debridement or admission for IV antibiotics) but superficial infection (defined as oral antibiotics alone needed without admission or debridement) did not reach statistical significance (Table 1). Multiple secondary outcomes or complications that might occur due to anemia or transfusion were not different between the two groups. Conclusion: This study shows a conservative transfusion strategy of 5.5 g/dL in an asymptomatic young Orthopaedic trauma patient leads to a lower deep infection rate without an increase in adverse outcomes.Item Correction to: Cluster identification, selection, and description in Cluster randomized crossover trials: the PREP-IT trials(BioMed Central, 2020-09-30) Sprague, Sheila; Scott, Taryn; Dodds, Shannon; Pogorzelski, David; McKay, Paula; Harris, Anthony D.; Wood, Amber; Thabane, Lehana; Bhandari, Mohit; Mehta, Samir; Gaski, Greg; Boulton, Christina; Marcano-Fernández, Francesc; Guerra-Farfán, Ernesto; Hebden, Joan; O’Hara, Lyndsay M.; Slobogean, Gerard P.; Slobogean, Gerard P.; Sprague, Sheila; Wells, Jeffrey; Bhandari, Mohit; D’Alleyrand, Jean-Claude; Harris, Anthony D.; Mullins, Daniel C.; Thabane, Lehana; Wood, Amber; Della Rocca, Gregory J.; Hebden, Joan; Jeray, Kyle J.; Marchand, Lucas; O’Hara, Lyndsay M.; Zura, Robert; Gardner, Michael J.; Blasman, Jenna; Davies, Jonah; Liang, Stephen; Taljaard, Monica; Devereaux, P. J.; Guyatt, Gordon H.; Heels-Ansdell, Diane; Marvel, Debra; Palmer, Jana; Friedrich, Jeff; O’Hara, Nathan N.; Grissom, Frances; Gitajn, I. Leah; Morshed, Saam; O’Toole, Robert V.; Petrisor, Bradley A.; Camara, Megan; Mossuto, Franca; Joshi, Manjari G.; Fowler, Justin; Rivera, Jessica; Talbot, Max; Dodds, Shannon; Garibaldi, Alisha; Li, Silvia; Nguyen, Uyen; Pogorzelski, David; Rojas, Alejandra; Scott, Taryn; Del Fabbro, Gina; Szasz, Olivia Paige; McKay, Paula; Howe, Andrea; Rudnicki, Joshua; Demyanovich, Haley; Little, Kelly; Mullins, C. Daniel; Medeiros, Michelle; Kettering, Eric; Hale, Diamond; Eglseder, Andrew; Johnson, Aaron; Langhammer, Christopher; Lebrun, Christopher; Manson, Theodore; Nascone, Jason; Paryavi, Ebrahim; Pensy, Raymond; Pollak, Andrew; Sciadini, Marcus; Degani, Yasmin; Demyanovich, Haley K.; Joseph, Katherine; Petrisor, Brad A.; Johal, Herman; Ristevski, Bill; Williams, Dale; Denkers, Matthew; Rajaratnam, Krishan; Al-Asiri, Jamal; Leonard, Jordan; Marcano-Fernández, Francesc A.; Gallant, Jodi; Persico, Federico; Gjorgjievski, Marko; George, Annie; Natoli, Roman M.; Gaski, Greg E.; McKinley, Todd O.; Virkus, Walter W.; Sorkin, Anthony T.; Szatkowski, Jan P.; Baele, Joseph R.; Mullis, Brian H.; Hill, Lauren C.; Hudgins, Andrea; Osborn, Patrick; Pierrie, Sarah; Martinez, Eric; Kimmel, Joseph; Adams, John D.; Beckish, Michael L.; Bray, Christopher C.; Brown, Timothy R.; Cross, Andrew W.; Dew, Timothy; Faucher, Gregory K.; Gurich, Richard W.; Lazarus, David E.; Millon, S. John; Palmer, M. Jason; Porter, Scott E.; Schaller, Thomas M.; Sridhar, Michael S.; Sanders, John L.; Rudisill, L. Edwin; Garitty, Michael J.; Poole, Andrew S.; Sims, Michael L.; Walker, Clark M.; Carlisle, Robert M.; Hofer, Erin Adams; Huggins, Brandon S.; Hunter, Michael D.; Marshall, William A.; Ray, Shea Bielby; Smith, Cory D.; Altman, Kyle M.; Bedard, Julia C.; Loeffler, Markus F.; Pichiotino, Erin R.; Cole, Austin A.; Maltz, Ethan J.; Parker, Wesley; Ramsey, T. Bennett; Burnikel, Alex; Colello, Michael; Stewart, Russell; Wise, Jeremy; Moody, M. Christian; Tanner, Stephanie L.; Snider, Rebecca G.; Townsend, Christine E.; Pham, Kayla H.; Martin, Abigail; Robertson, Emily; Miclau, Theodore; Kandemir, Utku; Marmor, Meir; Matityahu, Amir; McClellan, R. Trigg; Meinberg, Eric; Shearer, David; Toogood, Paul; Ding, Anthony; Donohue, Erin; Belaye, Tigist; Berhaneselase, Eleni; Paul, Alexandra; Garg, Kartik; Gary, Joshua L.; Warner, Stephen J.; Munz, John W.; Choo, Andrew M.; Achor, Timothy S.; Routt, Milton L. “ Chip”; Rao, Mayank; Pechero, Guillermo; Miller, Adam; Hagen, Jennifer E.; Patrick, Matthew; Vlasak, Richard; Krupko, Thomas; Sadasivan, Kalia; Koenig, Chris; Bailey, Daniel; Wentworth, Daniel; Van, Chi; Schwartz, Justin; Dehghan, Niloofar; Jones, Clifford B.; Watson, J. Tracy; McKee, Michael; Karim, Ammar; Talerico, Michael; Sietsema, Debra L.; Williams, Alyse; Dykes, Tayler; Obremskey, William T.; Jahangir, Amir Alex; Sethi, Manish; Boyce, Robert; Stinner, Daniel J.; Mitchell, Phillip; Trochez, Karen; Rodriguez, Andres; Gajari, Vamshi; Rodriguez, Elsa; Pritchett, Charles; Boulton, Christina; Lowe, Jason; Wild, Jason; Ruth, John T.; Taylor, Michel; Seach, Andrea; Saeed, Sabina; Culbert, Hunter; Cruz, Alejandro; Knapp, Thomas; Hurkett, Colin; Lowney, Maya; Prayson, Michael; Venkatarayappa, Indresh; Horne, Brandon; Jerele, Jennifer; Clark, Linda; Marcano-Fernández, Francesc; Jornet-Gibert, Montsant; Martínez-Carreres, Laia; Martí-Garín, David; Serrano-Sanz, Jorge; Sánchez-Fernández, Joel; Sanz-Molero, Matsuyama; Carballo, Alejandro; Pelfort, Xavier; Acerboni-Flores, Francesc; Alavedra-Massana, Anna; Anglada-Torres, Neus; Berenguer, Alexandre; Cámara-Cabrera, Jaume; Caparros-García, Ariadna; Fillat-Gomà, Ferran; Fuentes-López, Ruben; Garcia-Rodriguez, Ramona; Gimeno-Calavia, Nuria; Graells-Alonso, Guillem; Martínez-Álvarez, Marta; Martínez-Grau, Patricia; Pellejero-García, Raúl; Ràfols-Perramon, Ona; Peñalver, Juan Manuel; Domènech, Mònica Salomó; Soler-Cano, Albert; Velasco-Barrera, Aldo; Yela-Verdú, Christian; Bueno-Ruiz, Mercedes; Sánchez-Palomino, Estrella; Guerra-Farfán, Ernesto; García, Yaiza; Romeo, Nicholas M.; Vallier, Heather A.; Breslin, Mary A.; Fraifogl, Joanne; Wilson, Eleanor S.; Wadenpfuhl, Leanne K.; Halliday, Paul G.; Viskontas, Darius G.; Apostle, Kelly L.; Boyer, Dory S.; Moola, Farhad O.; Perey, Bertrand H.; Stone, Trevor B.; Lemke, H. Michael; Zomar, Mauri; Spicer, Ella; Fan, Chen “Brenda”; Payne, Kyrsten; Phelps, Kevin; Bosse, Michael; Karunakar, Madhav; Kempton, Laurence; Sims, Stephen; Hsu, Joseph; Seymour, Rachel; Churchill, Christine; Bartel, Claire; Mayberry, Robert Miles; Brownrigg, Maggie; Girardi, Cara; Mayfield, Ada; Hymes, Robert A.; Schwartzbach, Cary C.; Schulman, Jeff E.; Malekzadeh, A. Stephen; Holzman, Michael A.; Ramsey, Lolita; on behalf of the PREP-IT Investigators; Orthopaedic Surgery, School of MedicineAn amendment to this paper has been published and can be accessed via the original article.Item Intramedullary Nailing of Periarticular Fractures(Wolters Kluwer, 2018-08) Virkus, Walter; Kempton, Laurence; Sorkin, Anthony; Gaski, Greg; Orthopaedic Surgery, School of MedicinePlate fixation has historically been the preferred surgical treatment method for periarticular fractures of the lower extremity. This trend has stemmed from difficulties with fracture reduction and concerns of inadequate fixation with intramedullary implants. However, the body of literature on management of periarticular fractures of the lower extremities has expanded in recent years, indicating that intramedullary nailing of distal femur, proximal tibia, and distal tibia fractures may be the preferred method of treatment in some cases. Intramedullary nailing reliably leads to excellent outcomes when performed for appropriate indications and when potential difficulties are recognized and addressed.Item Patient and stakeholder engagement learnings: PREP-IT as a case study(Future Medicine, 2021-04) Medeiros, Michelle; Love, T Rosie; Slobogean, Gerard P.; Sprague, Sheila; Perfetto, Eleanor M.; O'Hara, Nathan N.; Mullins, C. Daniel; Slobogean, Gerard P.; Sprague, Sheila; Wells, Jeffrey; Bhandari, Mohit; D'alleyrand, Jean-Claude; Harris, Anthony; Mullins, Daniel C.; Thabane, Lehana; Wood, Amber; Della Rocca, Gregory J.; Hebden, Joan; Jeray, Kyle J.; Marchand, Lucas; O'Hara, Lyndsay M.; Zura, Robert; Gardner, Michael J.; Blasman, Jenna; Davies, Jonah; Liang, Stephen; Taljaard, Monica; Devereaux, Pj; Guyatt, Gordon H.; Heels-Ansdell, Dianne; Marvel, Debra; Palmer, Jana; Friedrich, Jeff; O'Hara, Nathan; Grissom, Frances; Gitajn, Leah; Morshed, Saam; O'Toole, Robert; Petrisor, Bradley A.; Camara, Megan; Mossuto, Franca; Joshi, Manjari G.; Fowler, Justin; Rivera, Jessica; Talbot, Max; Dodds, Shannon; Garibaldi, Alisha; Li, Silvia; Nguyen, Uyen; Pogorzelski, David; Rojas, Alejandra; Scott, Taryn; Del Fabbro, Gina; Szasz, Olivia Page; McKay, Paula; Howe, Andrea; Rudnicki, Joshua; Demyanovich, Haley; Little, Kelly; Medeiros, Michellic; Kettering, Eric; Hale, Diamond; Polk, Genevieve; Mahal, Nirmen; Eglseder, Andrew; Johnson, Aaron; Langhammer, Christopher; Lebrun, Christopher; Manson, Theodore; Nascone, Jason; Paryavi, Ebrahim; Pensy, Raymond; Pollack, Andrew; Sciadini, Marcus; Degani, Yasmin; Joseph, Katherine; Natoli, Roman M.; Gaski, Greg E.; McKinley, Todd O.; Virkus, Walter W.; Sorkin, Anthony T.; Szatkowski, Jan P.; Baele, Joseph R.; Mullis, Brian H.; Hill, Lauren C.; Hudgins, Andrea; Osborn, Patrick; Fowler, Justin; Pierrie, Sarah; Martinez, Eric; Kimmel, Joseph; Adams, John D.; Beckish, Michael; Bray, Christopher; Brown, Timothy R.; Cross, Andrew W.; Dew, Timothy; Faucher, Gregory; Gurich Jr, Richard W.; Lazarus, David E.; Millon, S. John; Palmer, M. Jason; Porter, Scott E.; Schaller, Thomas M.; Sridhar, Michael S.; Sanders, John L.; Rudisill Jr, L. Edwin; Garitty, Michael J.; Poole, Andrew S.; Sims, Michael L.; Walker, Clark M.; Carlisle II, Robert M.; Hofer, Erin Adams; Huggins, Brandon S.; Hunter, Michael D.; Marshall, William A.; Ray, Shea Bielby; Smith, Cory D.; Altman, Kyle M.; Bedard, Julia C.; Loeffler, Markus F.; Pichiotino, Erin R.; Cole, Austin A.; Maltz, Ethan J.; Parker, Wesley; Ramsey, T. Bennett; Burnikel, Alex; Colello, Michael; Stewart, Russell; Wise, Jeremy; Moody, M. Christian; Tanner, Stephanie L.; Snider, Rebecca G.; Townsend, Christine E.; Pham, Kayla H.; Martin, Abigail; Robertson, Emily; Miclau, Theodore; Kandemir, Utku; Marmor, Meir; Matityahu, Amir; McClellan, R. Trigg; Meinberg, Eric; Shearer, David; Toogood, Paul; Ding, Anthony; Donohue, Erin; Belaye, Tigist; Berhaneselase, Eleni; Paul, Alexandra; Garg, Kartik; Gary, Joshua L.; Warner, Stephen J.; Munz, John W.; Choo, Andrew M.; Achor, Timothy; Routt, Milton L. "Chip"; Rao, Mayank; Pechero, Guillermo; Miller, Adam; Hagen, Jennifer E.; Patrick, Matthew; Vlasak, Richard; Krupko, Thomas; Sadasivan, Kalia; Koenig, Chris; Bailey, Daniel; Wentworth, Daniel; Van, Chi; Schwartz, Justin; Dehghan, Niloofar; Jones, Clifford B.; Watson, J. Tracy; McKee, Michael; Karim, Ammar; Talerico, Michael; Sietsema, Debra L.; William, Alyse; Dykes, Tayler; Obremskey, William T.; Jahangir, Amir Alex; Sethi, Manish; Boyce, Robert; Stinner, Daniel J.; Mitchell, Phillip; Trochez, Karen; Rodriguez, Andres; Gajari, Vamshi; Rodriguez, Elsa; Pritchett, Chris; Boulton, Christina; Lowe, Jason; Wild, Jason; Ruth, John T.; Taylor, Michel; Seach, Andrea; Saeed, Sabina; Culbert, Hunter; Crus, Alejandro; Knapp, Thomas; Hurkett, Colin; Lowney, Maya; Prayson, Michael; Venkatarayappa, Indresh; Horne, Brandon; Jerele, Jennifer; Clark, Linda; Marcano-Fernández, Francesc; Jornet-Gibert, Montsant; Martínez-Carreres, Laia; Martí-Garín, David; Serrano-Sanz, Jorge; Sánchez-Fernández, Joel; Sanz-Molero, Matsuyama; Carballo, Alejandro; Pelfort, Xavier; Acerboni-Flores, Francesc; Alavedra-Massana, Anna; Anglada-Torres, Neus; Berenguer, Alexandre; Cámara-Cabrera, Jaume; Caparros-García, Ariadna; Fillat-Gomà, Ferran; Fuentes-López, Ruben; Garcia-Rodriguez, Ramona; Gimeno-Clavia, Nuria; Graells-Alonso, Guillem; Martínez-álvarez, Marta; Martínez-Grau, Patricia; Pellejero-García, Raúl; Ràfols-Perramon, Ona; Peñalver, Juan Manuel; Salomò Domènech, Mònica; Soler-Cano, Albert; Velasco-Barrera, Aldo; Yela-Verdú, Christian; Bueno-Ruiz, Mercedes; Sánchez-Palomino, Estrella; Guerra-Farfán, Ernesto; García, Yaiza; Romeo, Nicholas M.; Vallier, Heather A.; Breslin, Mary A.; Fraifogl, Joanne; Wilson, Eleanor S.; Wadenpfuhl, Leanne K; Halliday, Paul G.; Viskontas, Darius G.; Apostle, Kelly L.; Boyer, Dory S.; Moola, Farhad O.; Perey, Bertrand H.; Stone, Trevor B.; Lemke, H. Michael; Zomar, Mauri; Spicer, Ella; Fan, Chen "Brenda"; Payne, Kyrsten; Phelps, Kevin; Bosse, Michael; Karunakar, Madhav; Kempton, Laurence; Sims, Stephen; Hsu, Joseph; Seymour, Rachel; Churchill, Christine; Bartel, Claire; Mayberry, Robert Miles; Brownrigg, Maggie; Girardi, Cara; Mayfield, Ada; Hymes, Robert A.; Schwartzbach, Cary C.; Schulman, Jeff E.; Malekzadeh, A. Stephen; Holzman, Michael A.; Ramsey, Lolita; Ahn, James S.; Panjshiri, Farhanaz; Das, Sharmistha; English, Antoinisha D.; Haaser, Sharon M.; Cuff, Jaslynn A.N.; Pilson, Holly; Carroll, Eben A.; Halvorson, Jason J.; Babcock, Sharon; Goodman, J. Brett; Holden, Martha B.; Bullard, Debra; Williams, Wendy; Higgins, Thomas F.; Haller, Justin M.; Rothberg, David L.; Neese, Ashley; Russell, Mark; Coe, Marcus; Dwyer, Kevin; Mullin, Devin S.; Reily, Clifford A; DePalo, Peter; Hall, Amy E.; Heng, Marilyn; Harris, Mitchel B.; Smith, R. Malcolm; Lhowe, David W.; Esposito, John; Bansal, Mira; Bergin, Patrick F.; Russell, George V.; Graves, Matthew L.; Morellato, John; Champion, Heather K.; Johnson, Leslie N.; McGee, Skeketha L.; Bhanat, Eldrin L.; Mehta, Samir; Donegan, Derek; Ahn, Jaimo; Horan, Annamarie; Dooley, Mary; Kuczinski, Ashley; Iwu, Ashley; Potter, David; VanDemark II, Robert; Pfaff, Branden; Hollinsworth, Troy; Weaver, Michael J.; von Keudel, Arvind G.; McTague, Michael F.; Allen, Elizabeth M.; Jaeblon, Todd; Beer, Robert; Gage, Mark J.; Reilly, Rachel M.; Sparrow, Cindy; Paniagua, Ariana; Orthopaedic Surgery, School of MedicineItem Potential Benefits of Limited Clinical and Radiographic Follow-up After Surgical Treatment of Ankle Fractures(Wolters Kluwer, 2021-05-11) Friedman, Lisa G.M.; Sanchez, Daniela; Zachos, Terri A.; Marcantonio, Andrew; Audet, Megan; Vallier, Heather; Mullis, Brian; Myers-White, Adam; Kempton, Laurence; Watts, Jeffrey; Horwitz, Daniel S.; Orthopaedic Surgery, School of MedicineIntroduction: Ankle fractures are one of the most prevalent musculoskeletal injuries, with a significant number requiring surgical treatment. Postoperative complications requiring additional interventions frequently occur during the early postoperative period. We hypothesize that there is a limited need for routine clinical and radiographic follow-up once the fracture is deemed healed. Methods: IRB approval was obtained at four academic trauma centers. A retrospective chart review was done to identify adults with healed unimalleolar and bimalleolar ankle fractures treated surgically with at least 12 months of follow-up. Based on postoperative radiographs, changes in fracture alignment and implant position from radiographic union to final follow-up were documented. The average reimbursement for a final follow-up clinic visit and a set of ankle radiographs were estimated. Results: A total of 140 patients met inclusion criteria. The mean age at injury was 49.5 years, and 67.9% of patients were female. The mean time to healing was 82.2 days (±33.5 days). After radiographic healing, one patient had radiographic changes but was asymptomatic and full weight bearing at their final follow-up. On average, our institution was reimbursed $46 to $49 for a follow-up clinic visit and $364 to $497 for a set of ankle radiographs. Conclusion: Given the average time to healing, there is limited utility in routine radiographic and clinical follow-up beyond 16 weeks in asymptomatic patients. In our series, this would result in a savings of $950 to $1,200 per patient. However, after ankle fractures were deemed healed, 0.7% patients had radiographic evidence of a change in implant position. Documenting this change did not modify the immediate course of fracture treatment. Surgeons will need to balance the need for routine follow-up with the potential economic benefits in reducing costs to the healthcare system.Item Unilateral Sacral Fractures Demonstrate Slow Recovery of Patient Reported Outcomes Irrespective of Treatment(Wolters Kluwer, 2021-08) Mullis, Brian H.; Agel, Julie; Jones, Cliff; Lowe, Jason; Vallier, Heather; Teague, David; Kempton, Laurence; Schmidt, Andrew; Friess, Darin; Morshed, Saam; Miller, Anna; Leighton, Ross; Tornetta, Paul III; Orthopaedic Surgery, School of MedicineObjectives: To report functional outcomes of unilateral sacral fractures treated both operatively and nonoperatively Design: Prospective, multicenter, observational Setting: 16 level 1 trauma centers Patients/participants: Skeletally mature patients with unilateral zone 1 or 2 sacral fractures categorized as: displaced nonoperative (DN), displaced operative (DO), nondisplaced nonoperative (NN), nondisplaced operative (NO) Main outcome measurements: Pelvic displacement was documented on injury plain radiographs. Short Musculoskeletal Function Assessment (SMFA) scores were obtained at baseline and 3, 6, 12, and 24 months following injury. Displacement was defined as greater than 5 mm in any plane at the time of injury. Results: 286 patients with unilateral sacral fractures were initially enrolled, mean age 40 and mean Injury Severity Score (ISS) 16 were included. One hundred twenty-three patients completed 2 year follow up as follows; 29 DN, 30 DO, 47 NN, and 17 NO with 56% loss to follow-up at 2 years. Highest dysfunction was seen at 3 months for all groups with mean SMFA dysfunction scores; 25 DN, 28 DO, 27 NN, 31 NO. Mean SMFA scores at 2 years for all groups were 13 DN, 12 DO, 17 NN, 17 NO. Conclusions: All groups (operative/nonoperative and displaced/non-displaced) reported worst function 3 months following injury and all but (DN) continued to recover for 2 years following injury, with peak recovery for DN seen at 1 year. No functional benefit was seen with operative intervention for either displaced or non-displaced injuries at any time point.