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2018 Abstracts 06-01-18 Pk MID-AMERICA ORTHOPAEDIC ASSOCIATION 36th Annual Meeting April 18-22, 2018 Hyatt Regency Hill Country Resort San Antonio, TX Podium and Poster Abstracts NOTE: Disclosure information is listed at the end of this document. *Denotes presenter MAOA FIRST PLENARY SESSION April 18, 2018 Is the Prevalence of Ulnar Artery Thrombosis Higher in Orthopedic Surgeons? Abstract ID: Paper 001 *Chelsea S. Mathews, M.D. / Little Rock, AR Karan D. Dua, M.D. / Baltimore, MD Austin A. Cole / Little Rock, AR Eric R. Siegel, M.S. / Little Rock, AR Joshua M. Abzug, M.D. / Baltimore, MD Theresa O. Wyrick, M.D. / Little Rock, AR INTRODUCTION: Ulnar artery thrombosis (UAT), or hypothenar hammer syndrome, has strong correlations with individuals involved in manual labor and various athletic professions. Activities that produce a persistent impact on the hypothenar eminence can damage blood vessels of the hand, specifically the ulnar artery as it passes through Guyon’s canal. To our knowledge, the prevalence of these symptoms residing in orthopedic surgeons is unknown. We hypothesized that orthopedic surgeons would have an increased prevalence of UAT than the general population and that this would be true of surgeons who perform a large volume of hip and knee arthroplasty due to frequent use of oscillating saws and methods of retractor placement. METHODS: 80 current, retired, and resident orthopedic surgeons at two separate institutions were surveyed for symptoms of ulnar artery thrombosis (UAT). Participants completed surveys indicating symptoms of UAT and participation in leisurely activities that may also increase their risk. A timed Allen’s test was performed with the radial artery occluded and the time to reperfusion of the hand was measured. A result of >6 seconds to reperfusion was noted as abnormal. The ulnar artery was also dopplered proximal to the wrist flexor crease to ensure proximal patency and flow. Fisher’s exact test was used to compare UAT incidence between participants and the general population, and between participant subgroups defined by number of years in practice, subspecialty practice, and volume of arthroplasty cases performed per month. RESULTS: Ten participants had an Allen’s test with reperfusion occurring at >6 seconds. One of these was a false positive with increased Allen’s test but no symptoms to indicate pathology. All participants had positive doppler studies proximal to wrist crease. The incidence of UAT in our study population was 11% (9/80) compared to 1.6% (21/1300) in the general population (P<0.001). With resident physicians excluded, the incidence was 16% (9/55). Physicians in practice >15 years had a significantly higher rate of UAT (24%) compared to those who had practiced for <15 years (2%)(P=0.0030). The incidence of UAT in adult reconstruction surgeons was 40% (2/5) compared to only 9% (7/75) in other subspecialties, but this was not statistically significant (P=0.095). CONCLUSIONS: Based on the prevalence in this cohort, orthopaedic surgeons are at a greatly increased risk of ulnar artery thrombosis compared to the general population. The risk of ulnar artery thrombosis appears to increase with year of practice and may increase with increased number of arthroplasty cases performed. Extended Oral Antibiotic Prophylaxis in High Risk Patients Substantially Reduces Primary Total Hip and Knee Arthroplasty 90-Day Infection Rate Abstract ID: Paper 002 Avinash Inabathula, B.S. / Indianapolis, IN Julian Dilley, B.S. / Indianapolis, IN Mary Ziemba-Davis, B.A./ Fishers, IN *Lucian C. Warth, M.D. / Indianapolis, IN Khalid Azzam, M.D. / Indianapolis, IN Philip H. Ireland, M.D. / Fishers, IN R. Michael Meneghini, M.D. / Indianapolis, IN BACKGROUND: Total joint arthroplasty (TJA) bundled and episodic payment models shift risk and cost associated with periprosthetic joint infection (PJI) to surgeons and hospitals. This causes some to avoid treating high-risk patients, subsequently burdening academic and tertiary care centers. In addition, there is little data that supports optimizing host risk factors preoperatively will subsequently decrease PJI rates, and there is recent data supporting extended oral antibiotic prophylaxis in reimplantation TJA. The study purpose was to evaluate whether extended oral antibiotic prophylaxis can minimize PJI in high-risk primary TJA patients. METHODS: A retrospective cohort study of 2,260 primary hip and knee arthroplasties from 2011 through 2016 at a suburban academic hospital with modern perioperative and infection- prevention protocols. Beginning January 2015, extended oral antibiotic prophylaxis for 7 days after discharge was implemented for all patients at high risk (diabetes, obesity, autoimmune disease, end-stage kidney disease, etc.) for PJI. All patients diagnosed with PJI within 90 days were identified and statistically compared between groups with p<0.05 statistically significant. RESULTS: 1350 patients (59.7%) had one or more risk factors for PJI, and 34.7% of the entire cohort was discharged on extended prophylactic antibiotics. The overall 90-day periprosthetic infection rate was 1.5%. Infection rates were 1.1% (9/831) for patients without risk factors, 3.0% (19/641) for high-risk patients without extended antibiotics, and 0.6% (5/788) for high-risk patients discharged on extended antibiotic prophylaxis (p=0.001). The only non-protocol covariate to increase infection rate was use of a peri-articular injection with liposomal bupivacaine (p=0.013). CONCLUSIONS: In selected patients at high risk for infection after primary TJA, a statistically significant and clinically meaningful reduction in 90-day infection rate can be realized with extended postoperative oral antibiotic prophylaxis. Further study is warranted before widespread adoption to ensure this protocol does not promote antimicrobial resistance and supports appropriate antibiotic stewardship. Outcomes with Overlapping Surgery at a Large Academic Medical Center Abstract ID: Paper 003 *Bradley W. Wills, M.D. Brent A. Ponce, M.D. Parke W. Hudson, M.D. Shawna L. Watson, M.D. Jorge L. Perez, M.D. Austin Starnes, M.D. Loring W. Rue, M.D. Gerald McGwin, M.D. Ibukunoluma B. Araoye, M.D. Birmingham, AL BACKGROUND: Overlapping surgery (OS) is the practice of an attending physician providing supervision to two surgeries that are scheduled at overlapping times. Recent media and government attention has raised concerns about this practice and the need for informed patient consent. The purpose of this study was to evaluate the efficiency and safety of Overlapping Surgery at a training institution by comparing it to non-overlapping surgery (NO) with respect to operative time, mortality, readmissions, and complications. METHODS: A population-based, retrospective, cohort study was conducted using data on inpatient and ambulatory operative procedures from January 1, 2014, to December 31, 2015. Patients who had undergone surgery by attending surgeons who performed 10% or more of their cases overlapping were selected. OS was defined as any portion of a case overlapping with another case by the same surgeon. Additionally, patients were stratified by the surgical specialty of their surgeon. 30-day mortality, readmission within 30 days, and seven patient safety indicators (PSIs) were recorded. RESULTS: A total of 26,260 and 15,106 cases met our criteria for analysis for surgical time and outcomes, respectively. OS patients had an average case length of 2.18 hours compared to 1.64 hours among NO patients, (p<0.0001), a decreased risk of mortality (relative risk [RR] 0.42, 95% confidence interval [CI] 0.34-0.52, p<0.0001), a decreased risk of readmission (RR 0.92, 95% CI 0.86-0.98, p=0.0148), and a decreased risk of experiencing any PSI (RR 0.67, 95% CI 0.55-0.83, p=0.0002). SUMMARY: The present study confirms prior reports and addresses gaps in the literature regarding OS, such as the effect of resident involvement and the individual effect of OS in 13 different surgical specialties. The findings highlight the need for additional investigation and suggest that the practice of overlapping surgery does not expose patients to increased risk of negative outcomes. Use of Closed Incisional Negative Pressure Wound Therapy After Revision Total Hip and Knee Arthroplasty in Patients at High Risk for Infection - A Prospective, Randomized Clinical Trial Abstract ID: Paper 004 Jared M. Newman, M.D. Marcelo B. P. Siqueira, M.D. George A. Yakubek, D.O. *Alison K. Klika, M.S. Wael K. Barsoum, M.D. Carlos A. Higuera, M.D. Cleveland, OH BACKGROUND: Continuous wound drainage after revision total hip (THA) and knee arthroplasty (TKA) can lead to the development of a periprosthetic joint infection (PJI). Closed incisional negative pressure wound therapy (ciNPWT) has been reported to help alleviate drainage and other wound complications. The purpose of this study was to compare the use of ciNPWT with a silver-impregnated occlusive dressing, in high risk patients who underwent revision THA and TKA. Specifically, we evaluated: (1) wound complications, (2) re-admissions, and (3) re-operations that occurred within 12 weeks of revision THA and TKA. METHODS: A total of 160 patients undergoing elective revision THA or TKA were prospectively randomized to receive either ciNPWT or a silver-impregnated occlusive dressing after surgery in a single institution. Patients were included if they had at least one risk factor for developing wound complication(s): BMI >35, anticoagulant use other than aspirin, peripheral vascular disease, depression, diabetes mellitus, current smoker, history of PJI, current use of corticosteroids or immunomodulators, current history of malignancy, rheumatologic disease, kidney disease and/or dialysis, malnutrition, liver disease, history of organ transplant, or HIV. Wound complication, re-admission, and re-operation rates were collected at 2, 4, and 12 weeks postoperatively. RESULTS: There were no significant differences between groups in terms of demographics or perioperative factors, except for septic revisions and the reason for revision. The mean number of risk factors was slightly higher in the controls (2.7 vs.
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