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The Bone & Joint Journal
Vol. 98-B, Issue 3 | Pages 425 - 432
1 Mar 2016
Samuel AM Lukasiewicz AM Webb ML Bohl DD Basques BA Varthi AG Leslie MP Grauer JN

Aims. While use of large national clinical databases for orthopaedic trauma research has increased dramatically, there has been little study of the differences in populations contained therein. In this study we aimed to compare populations of patients with femoral shaft fractures across three commonly used national databases, specifically with regard to age and comorbidities. Patients and Methods. Patients were identified in the Nationwide Inpatient Sample (NIS), National Surgical Quality Improvement Program (NSQIP) and National Trauma Data Bank (NTDB). . Results. The distributions of age and Charleston comorbidity index (CCI) reflected a predominantly older population with more comorbidities in NSQIP (mean age 71.5; . sd. 15.6), mean CCI 4.9; . sd. 1.9) than in the NTDB (mean age 45.2; . sd. 21.4), mean CCI = 2.1; . sd. 2.0). Bimodal distributions in the NIS population showed a more mixed population (mean age 56.9; . sd.  24.9), mean CCI 3.2; . sd. 2.3). Differences in age and CCI were all statistically significant (p <  0.001). . Conclusion. While these databases have been commonly used for orthopaedic trauma research, differences in the populations they represent are not always readily apparent. Care must be taken to understand fully these differences before performing or evaluating database research, as the outcomes they detail can only be analysed in context. Take home message: Researchers and those evaluating research should be aware that orthopaedic trauma populations contained in commonly studied national databases may differ substantially based on sampling methods and inclusion criteria. Cite this article: Bone Joint J 2016;98-B:425–32


The Bone & Joint Journal
Vol. 99-B, Issue 9 | Pages 1216 - 1222
1 Sep 2017
Fu MC Boddapati V Gausden EB Samuel AM Russell LA Lane JM

Aims

We aimed to characterise the effect of expeditious hip fracture surgery in elderly patients within 24 hours of admission on short-term post-operative outcomes.

Patients and Methods

Patients age 65 or older that underwent surgery for closed femoral neck and intertrochanteric hip fractures were identified from the American College of Surgeons National Surgical Quality Improvement Program between 2011 and 2014. Multivariable propensity-adjusted logistic regressions were performed to determine associations between early surgery within 24 hours and post-operative complications, controlling for selection bias in patients undergoing early surgery based on observable characteristics.


The Bone & Joint Journal
Vol. 99-B, Issue 10 | Pages 1389 - 1398
1 Oct 2017
Stavem K Naumann MG Sigurdsen U Utvåg SE

Aims

This study assessed the association of classes of body mass index in kg/m2 (classified as normal weight 18.5 kg/m2 to 24.9 kg/m2, overweight 25.0 kg/m2 to 29.9 kg/m2, and obese ≥ 30.0 kg/m2) with short-term complications and functional outcomes three to six years post-operatively for closed ankle fractures.

Patients and Methods

We performed a historical cohort study with chart review of 1011 patients who were treated for ankle fractures by open reduction and internal fixation in two hospitals, with a follow-up postal survey of 959 of the patients using three functional outcome scores.


The Bone & Joint Journal
Vol. 98-B, Issue 2 | Pages 249 - 259
1 Feb 2016
Sabharwal S Carter AW Rashid A Darzi A Reilly P Gupte CM

Aims

The aims of this study were to estimate the cost of surgical treatment of fractures of the proximal humerus using a micro-costing methodology, contrast this cost with the national reimbursement tariff and establish the major determinants of cost.

Methods

A detailed inpatient treatment pathway was constructed using semi-structured interviews with 32 members of hospital staff. Its content validity was established through a Delphi panel evaluation. Costs were calculated using time-driven activity-based costing (TDABC) and sensitivity analysis was performed to evaluate the determinants of cost