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Browsing by Author "Kraus, Kent R."
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Item A Scoring System for Predicting Nonunion After Intramedullary Nailing of Femoral Shaft Fractures(Wolters Kluwer, 2024-09-04) Kraus, Kent R.; Flores, Joshua W.; Slaven, James E.; Sharma, Ishani; Arnold, Payton K.; Mullis, Brian H.; Natoli, Roman M.; Orthopaedic Surgery, School of MedicineIntroduction: Femoral shaft nonunion negatively affects patient quality of life. Although multiple risk factors have been identified for femoral shaft nonunion after intramedullary nail (IMN) fixation, there is no quantitative model for predicting nonunion. Study description: The study is a retrospective cohort study of patients with femoral shaft fractures treated at two level one trauma centers who were followed to fracture union or nonunion. Patient, injury, and surgical characteristics were analyzed to create a quantitative model for nonunion risk after intramedullary nailing. Methods: Eight hundred one patients aged 18 years and older with femoral shaft fractures treated with reamed, locked IMNs were identified. Risk factors including demographics, comorbidities, surgical variables, and injury-related characteristics were evaluated. Multivariate analysis was conducted, and several variables were included in a scoring system to predict nonunion risk. Results: The overall nonunion rate was 7.62% (61/801). Multivariate analysis showed significant association among pulmonary injury (odds ratio [OR] = 2.19, P = 0.022), open fracture (OR=2.36, P = 0.02), current smoking (OR=3.05, P < 0.001), postoperative infection (OR=12.1, P = 0.007), AO/OTA fracture pattern type A or B (OR=0.43, P = 0.014), and percent cortical contact obtained intraoperatively ≥25% (OR=0.41, P = 0.021) and nonunion. The scoring system created to quantitatively stratify nonunion risk showed that a score of 3 or more yielded an OR of 6.38 for nonunion (c-statistic = 0.693, P < 0.0001). Conclusions: Femoral shaft nonunion risk is quantifiable based on several independent injury, patient, and surgical factors. This scoring system is an additional tool for clinical decision making when caring for patients with femoral shaft fractures treated with IMNs.Item Bibliometric Analysis of Gender Authorship Trends and Collaboration Dynamics over 30 Years of Spine 1985 to 2015(Wolters Kluwer, 2018-02) Brinker, Alexander R.; Liao, Jane L.; Kraus, Kent R.; Young, Jocelyn; Sandelski, Morgan; Mikesell, Carter; Robinson, Daniel; Adjei, Michael; Lunsford, Shatoria D.; Fischer, James; Kacena, Melissa A.; Whipple, Elizabeth C.; Loder, Randall T.; Orthopaedic Surgery, School of MedicineStudy Design. A bibliometric analysis. Objective. The aim of this article was to study bibliometric changes over the last 30 years of Spine. These trends are important regarding academic publication productivity. Summary of Background Data. Inflation in authorship number and other bibliometric variables has been described in the scientific literature. The issue of author gender is taking on increasing importance, as efforts are being made to close the gender gap. Methods. From 1985 to 2015, 10-year incremental data for several bibliometric variables were collected, including author gender. Standard bivariate statistical analyses were performed. Trends over time were assessed by the Cochran linear trend. A P < 0.05 was considered statistically significant. Results. Inclusion criteria were met for 1566 manuscripts. The majority of the manuscripts were from North America (51.2%), Europe (25.2%), and Asia (20.8%). The number of manuscripts, authors, countries, pages, and references all increased from 1985 to 2015. There was a slight increase in female first authors over time (17.5% to 18.4%, P = 0.048). There was no gender change over time for corresponding authors (14.3% to 14.0%, P = 0.29). There was an 88% increase in the percentage of female first authors having male corresponding authors (P = 0.00004), and a 123% increase in male first authors having female corresponding authors (P = 0.0002). The 14% to 18% of female authors in Spine is higher than the ∼5% female membership of the Scoliosis Research Society and North American Spine Society. Conclusion. Manuscripts in Spine over the past 30 years have shown a significant increase in the number of authors, collaborating institutions and countries, printed pages, references, and number of times each manuscript was cited. There has been a mild increase in female first authorship, but none in corresponding authorship. Increases in female authorship will likely require recruitment of more females into the discipline rather than providing females in the discipline with authorship opportunities. Level of Evidence: N/AItem The Effect of Tourniquet Use and Sterile CO2 Gas Bone Preparation on Cement Penetration in Primary Total Knee Arthroplasty(Elsevier, 2019) Gapinski, Zachary; Yee, Elliott; Kraus, Kent R.; Deckard, Evan R.; Meneghini, R. Michael; Orthopaedic Surgery, School of MedicineIntroduction Tourniquetless total knee arthroplasty (TKA) is experiencing resurgence in popularity due to potential pain control benefits. Further, optimal cement technique and implant fixation remain paramount to long-term cemented TKA success, as aseptic loosening continues to be a leading cause of revision. The purpose of this study was to determine how tourniquet use and/or novel bone preparation using sterile, compressed carbon dioxide (CO2) gas affected cement penetration in TKA. Methods A retrospective review was performed on 303 consecutive primary TKAs with the same implant in three groups: (1) a tourniquet without sterile CO2 compressed gas used for bone preparation, (2) no tourniquet with CO2 gas, and (3) tourniquet use and CO2 gas bone preparation. Cement penetration was measured on radiographs by two independent, blinded raters across seven zones defined by the Knee Society Radiographic Evaluation System. Results The three groups did not differ on age, BMI, or sex (p≥0.1). Cement penetration was greater in six of seven zones with significantly greater cement penetration in three zones (Tibial AP Zone 2, Femoral Lateral Zones 3A and 3P) in groups that utilized CO2 gas bone preparation compared to the tourniquet only group (p≤0.039). Conclusion Bone prepared with CO2 gas showed significantly more cement penetration in three zones with greater cancellous bone. The results suggest use of CO2 gas bone preparation may achieve greater cement penetration than using a tourniquet with lavage only.Item Is There Benefit in Keeping Early Discharge Patients Overnight After Total Joint Arthroplasty?(Elsevier, 2020-07-16) Kraus, Kent R.; Buller, Leonard T.; Caccavallo, Peter; Ziemba-Davis, Mary; Meneghini, R. Michael; Orthopaedic Surgery, School of MedicineIntroduction: In recent years, cost containment relative to patent safety and quality of care for total joint arthroplasty (TJA) has been a key focus for the Centers for Medicare and Medicaid Services (CMS) spawning significant research and programmatic change, including a move toward early discharge and outpatient TJA. TJA outpatients receive few, if any, medical interventions prior to discharge, but the type and quantity of medical interventions provided for TJA patients who stay overnight in the hospital is unknown. This study quantified the nature, frequency, and outcome of interventions occurring overnight after primary TJA. Methods: 1,725 consecutive primary unilateral TJAs performed between 2012 and 2017 by a single surgeon in a rapid-discharge program, managed by a perioperative internal medicine specialist, were reviewed. Medical records were examined for diagnostic tests, treatments, and procedures performed, results of interventions, and all-cause readmissions. Recorded interventions included any that varied from the preoperative treatment plan, were beyond standard-of-care, and could not be completed at home. Results: 759 patients were discharged on postoperative day one. 84% (641/759) received no medical interventions during their overnight hospital stay. Twelve (1.6%) received diagnostic tests, 90 (11.9%) received treatments, and 29 (3.8%) received procedures. 92% (11/12) of diagnostic tests were negative, 66% of 100 treatments in 90 patients were intravenous fluids for oliguria or hypotension, and all procedures were in/out catheterizations for urinary retention. 90-day all cause readmission rates were similar in patients who received (2.5%) and did not receive (3.3%) a clinical intervention. Conclusion: The majority of patients received no overnight interventions, suggesting unnecessary costly hospitalization. The most common issues addressed were oliguria, urinary retention, and hypotension. Protocols to prevent these conditions would facilitate outpatient TJA, improve patient safety, and reduce costs.