Kristin R Archer

Vanderbilt University, Nashville, Michigan, United States

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Publications (49)97.87 Total impact

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    ABSTRACT: Background and Objectives In 2002, with the advent of better classification techniques, the World Health Organization declassified malignant fibrous histiocytoma (MFH) as a distinct histological entity in favor of the reclassified entity high-grade undifferentiated pleomorphic sarcoma (HGUPS). To date, no study has evaluated comparative outcomes between patients designated historically in the MFH group and those classified in the new HGUPS classification. Our goal was to determine the presence of clinical prognostic implications that have evolved with this new nomenclature.Methods Sixty-eight patients were retrospectively evaluated between January 1998 and December 2007. Forty-five patients diagnosed with MFH between 1998 and 2003 were compared to 23 patients in the HGUPS group, from 2004 to 2007. Primary prognostic outcomes assessed included overall survival, metastatic-free, and local recurrence-free survival.ResultsFive-year survivorship between MFH and HGUPS populations, using Kaplan–Meier or competing risk methods, did not show statistical difference for overall survival (60% vs. 74%, P = 0.36), 5-year metastasis-free survival (31% vs. 26%, P = 0.67), or local recurrence-free survival (13% vs. 16%, P = 0.62).Conclusion Despite new classification nomenclature, there appears to be no identifiable prognostic implications for sarcomas that remain in the unclassifiable HGUPS group, as compared to the previously accepted MFH group. J. Surg. Oncol. © 2014 Wiley Periodicals, Inc.
    Journal of Surgical Oncology 09/2014; · 2.64 Impact Factor
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    ABSTRACT: To determine whether delirium during the hospital stay predicted health-related quality of life (HRQOL) at 1-year following injury in trauma intensive care unit (ICU) survivors without intracranial hemorrhage. We also examined the association between depressive and post-traumatic stress disorder (PTSD) symptoms and each of the HRQOL domains at 1-year follow-up.
    Archives of physical medicine and rehabilitation. 08/2014;
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    ABSTRACT: The negative consequences of narcotic use and diversion for nonmedical use are on the rise. A growing number of narcotic abusers obtain narcotic prescriptions from multiple providers ("doctor shopping"). This study sought to determine the effects of multiple postoperative narcotic providers on the number of narcotic prescriptions, duration of narcotics, and morphine equivalent dose per day in the orthopaedic trauma population.
    The Journal of bone and joint surgery. American volume. 08/2014; 96(15):1257-1262.
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    ABSTRACT: Opioids are commonly used for preoperative pain management in patients undergoing spine surgery. The objective of this investigation was to assess whether preoperative opioid use predicts worse self-reported outcomes in patients undergoing spine surgery.METHODS: Five hundred and eighty-three patients undergoing lumbar, thoracolumbar, or cervical spine surgery to treat a structural lesion were included in this prospective cohort study. Self-reported preoperative opioid consumption data were obtained at the preoperative visit and were converted to the corresponding daily morphine equivalent amount. Patient-reported outcome measures were assessed at three and twelve months postoperatively via the 12-Item Short-Form Health Survey and the EuroQol-5D questionnaire, as well as, when appropriate, the Oswestry Disability Index and the Neck Disability Index. Separate multivariable linear regression analyses were then performed.RESULTS: At the preoperative evaluation, of the 583 patients, 56% (326 patients) reported some degree of opioid use. Multivariable analyses controlling for age, sex, diabetes, smoking, surgery invasiveness, revision surgery, preoperative Modified Somatic Perception Questionnaire score, preoperative Zung Depression Scale score, and baseline outcome score found that increased preoperative opioid use was a significant predictor (p < 0.05) of decreased 12-Item Short-Form Health Survey and EuroQol-5D scores, as well as of increased Oswestry Disability Index and Neck Disability Index scores at three and twelve months postoperatively. Every 10-mg increase in daily morphine equivalent amount taken preoperatively was associated with a 0.03 decrease in the 12-Item Short-Form Health Survey physical component summary and mental component summary scores, a 0.01 decrease in the EuroQol-5D score, and a 0.5 increase in the Oswestry Disability Index and Neck Disability Index score at twelve months postoperatively. Higher preoperative Modified Somatic Perception Questionnaire and Zung Depression Scale scores were also significant negative predictors (p < 0.05).CONCLUSIONS: Increased preoperative opioid consumption, Modified Somatic Perception Questionnaire score, and Zung Depression Scale score prior to undergoing spine surgery predicted worse patient-reported outcomes. This suggests the potential benefit of psychological and opioid screening with a multidisciplinary approach that includes weaning of opioid use in the preoperative period and close opioid monitoring postoperatively.LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
    The Journal of bone and joint surgery. American volume. 06/2014; 96(11):e89.
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    ABSTRACT: To determine which work-related injuries are the most frequent and costly. Secondary analysis of workers' compensation claims data. Data was provided by a large, Maryland workers' compensation insurer from 1998 through 2008. None MAIN OUTCOMES MEASURES: For 45 injury types, the number of claims and compensation amount were calculated for total compensation as well as for medical and indemnity compensation separately. Back and knee injuries were the most frequently occurring single injury types, while heart attack and occupational disease were the most expensive in terms of mean compensation. When taking into account both the frequency and cost per of injury (mean cost*number occurrences), back, knee, and shoulder injuries were the most expensive single injury types. Successful prevention and management of back, knee, and shoulder injuries could lead to a substantial reduction in the burden associated with work-related injuries.
    Archives of physical medicine and rehabilitation 01/2014; · 2.18 Impact Factor
  • The Journal of Pain. 01/2014; 15(4):S1.
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    ABSTRACT: Prospective review of registry data at a single institution from October 2010 to June 2012. To assess whether the amount of preoperative narcotic use is associated with preoperative depression and anxiety in patients undergoing spine surgery for a structural lesion. Previous work suggests that narcotic use and psychiatric comorbidities are significantly related. Among other psychological considerations, depression and anxiety may be associated with the amount of preoperative narcotic use in patients undergoing spine surgery. Five hundred eighty-three patients undergoing lumbar (60%), thoracolumbar (11%), or cervical spine (29%) were included. Self-reported preoperative narcotic consumption was obtained at the initial preoperative visit and converted to daily morphine equivalent amounts. Preoperative Zung Depression Scale (ZDS) and Modified Somatic Perception Questionnaire (MSPQ) scores were also obtained at the initial preoperative visit and recorded as measures of depression and anxiety, respectively. Resistant and robust bootstrapped multivariable linear regression analysis was performed to determine the association between ZDS and MSPQ scores and preoperative narcotics, controlling for clinically important covariates. Mann-Whitney U tests examined preoperative narcotic use in patients who were categorized as depressed (ZDS ≥ 33) or anxious (MSPQ ≥ 12). Multivariable analysis controlling for age, sex, smoking status, preoperative employment status, and prior spinal surgery demonstrated that preoperative ZDS (P = 0.006), prior spine surgery (P = 0.007), and preoperative pain (0.014) were independent risk factors for preoperative narcotic use. Preoperative MSPQ (P = 0.083) was nearly a statistically significant risk factor. Patients who were categorized as depressed or anxious on the basis of ZDS and MSPQ scores also showed higher preoperative narcotic use than those who were not (P < 0.0001). Depression and anxiety as assessed by ZDS and MSPQ scores were significantly associated with increased preoperative narcotic use, underscoring the importance of thorough psychological and substance use evaluation in patients being evaluated for spine surgery.Level of Evidence: 2.
    Spine 12/2013; 38(25):2196-200. · 2.16 Impact Factor
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    ABSTRACT: Prior studies have demonstrated postoperative infection may confer a survival benefit after osteosarcoma resection. Our aim was to determine whether infection after soft tissue sarcoma resection has similar effects on metastasis, recurrence and survival. A retrospective review was conducted; 396 patients treated surgically for a soft tissue sarcoma between 2000 and 2008 were identified. Relevant oncologic data were collected. Fifty-six patients with a postoperative infection were compared with 340 patients without infection. Hazard ratios and overall cumulative risk were evaluated. There was no difference in survival, local recurrence or metastasis between patients with or without a postoperative infection. Patients were evenly matched for age at diagnosis, gender, smoking status, and diabetes status. Tumor characteristics did not differ between groups in tumor size, location, depth, grade, margin status, stage, and histologic subtype. There was no difference in utilization of chemotherapy or radiation therapy between groups. From our competing risk model, only positive margin status significantly impacted the risk of local recurrence. An increase in tumor size corresponded to an increased risk of metastasis and death. Postoperative infection neither conferred a protective effect, nor increased the risk of adverse oncologic outcomes after soft tissue sarcoma resection. J. Surg. Oncol. © 2013 Wiley Periodicals, Inc.
    Journal of Surgical Oncology 11/2013; · 2.64 Impact Factor
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    ABSTRACT: The fear-avoidance model offers a promising framework for understanding the development of chronic postoperative pain and disability. However, limited research has examined this model in patients undergoing spinal surgery. To determine whether preoperative and early postoperative fear of movement predicts pain, disability, and physical health at 6 months following spinal surgery for degenerative conditions, after controlling for depressive symptoms and other potential confounding variables. A prospective cohort study conducted at an academic outpatient clinic. One hundred forty-one patients undergoing surgery for lumbar or cervical degenerative conditions. Self-reported pain and disability were measured with the Brief Pain Inventory and the Oswestry Disability Index/Neck Disability Index, respectively. The physical composite scale of the 12-Item Short-Form Health Survey (SF-12) measured physical health. Data collection occurred preoperatively and at 6 weeks and 6 months following surgery. Fear of movement was measured with the Tampa Scale for Kinesiophobia and depression with the Prime-MD PHQ-9. One hundred and twenty patients (85% follow-up) completed the 6-month postoperative assessment. Multivariable mixed-method linear regression analyses found that early postoperative fear of movement (6 weeks) predicted pain intensity, pain interference, disability, and physical health at 6-month follow-up (p<.05). Preoperative and early postoperative depression predicted pain interference, disability, and physical health. Results provide support for the fear-avoidance model in a postsurgical spine population. Early postoperative screening for fear of movement and depressive symptoms that do not acutely improve following surgical intervention appears warranted. Cognitive and behavioral strategies may be beneficial for postsurgical patients with high fear of movement and/or depressive symptoms.
    The spine journal: official journal of the North American Spine Society 11/2013; · 2.90 Impact Factor
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    ABSTRACT: Patient satisfaction is a key determinant of quality of care and an important component of pay for performance metrics. The purpose of this study was to evaluate the impact of a simple intervention aimed to increase patients' understanding of their orthopaedic trauma surgeon and improve patient satisfaction with overall quality of inpatient care delivered by the attending surgeon. Prospective quality improvement initiative utilizing a randomized intervention SETTING:: Level 1 Academic trauma center PATIENTS/PARTICIPANTS:: 212 patients were eligible and 100 patients were randomized to the intervention group and 112 patients were randomized to the control group. Overall, 76 patients could be reached for follow-up satisfaction survey, including 34 patients in the intervention group and 42 patients in the control group. Patients randomized to the intervention group received an attending biosketch card, which included a picture of the attending orthopaedic surgeon with a brief synopsis of his educational background, specialty, surgical interests, and research interests. Our primary outcome measure was a patient satisfaction survey assessing patient rating of overall quality of inpatient care delivered by the attending surgeon. Overall, 25 of 34 patients (74%) that received an attending biosketch card reported "excellent overall quality of doctor care," while only 22 of 42 patients in the control group (52%) reported "excellent overall quality of doctor care" (p=0.05). Age, gender, race, education, insurance status, primary injury type, and length of hospital stay were not significant with reference to "excellent" outcome. Clinically significant improvements in satisfaction with overall quality of inpatient care by the attending surgeon were identified in patients that received a biosketch card of his or her attending orthopaedic surgeon. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
    Journal of orthopaedic trauma 10/2013; · 1.78 Impact Factor
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    ABSTRACT: To review homeless patients with orthopaedic trauma injuries and examine their ER utilization, follow-up rates, and complication rates DESIGN:: Retrospective chart review. Patients presenting to a Level I trauma center with orthopaedic trauma injuries from 2001-2010. Sixty-three uninsured, homeless patients and sixty-three uninsured, non-homeless patients with orthopaedic trauma injuries. Homeless orthopaedic trauma patients were identified through ER intake sheets and CPT code searches. ER usage, orthopaedic clinic follow-up, and complications. After the index visit to the ER for their orthopaedic trauma injuries, homeless patients demonstrated more ER visits and had fewer orthopaedic clinic follow-up visits than non-homeless patients (p < 0.001). There were no significant differences among the type of complications (none, infection, hardware failure, non-union) between the homeless and non-homeless patients (p = 0.23). Operative homeless patients returned to the orthopaedic clinic for follow-up more than non-operative homeless patients (M = 5.4, SD = 7.6; M = 1.2, SD = 1.5, respectively, p < 0.001). Our data is the first to examine the problems associated with homelessness in the orthopaedic trauma patient and demonstrates an increased challenge in follow-up care. The orthopaedic surgeon must consider these issues in managing this complex patient population. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
    Journal of orthopaedic trauma 09/2013; · 1.78 Impact Factor
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    ABSTRACT: Soft tissue sarcomas (STS) continue to be excised inappropriately without proper preoperative planning. The reasons for this remain elusive. The role of insurance status and patient distance from sarcoma center in influencing such inappropriate excisions were examined in this study. This retrospective review of a single institution prospective database evaluated 400 patients treated for STS of the extremities between January 2000 and December 2008. Two hundred fifty three patients had a primary excision while 147 patients underwent re-excision. Wilcoxon rank sum test and either χ(2) or Fisher's exact were used to compare variables. Multivariable regression analyses were used to take into account potential confounders and identify variables that affected excision status. Tumor size, site, depth, stage, margins, and histology were significantly different between the primary excision and re-excision groups; P < 0.05. Insurance status and patient distance from the treatment center were not statistically different between the two groups. Large and deep tumors and certain histology types predicted appropriate referral. Inappropriate excision of STS is not influenced by patient distance from a sarcoma center or by a patient's insurance status. In this study, tumor size, depth, and certain histology types predicted the appropriate referral of a STS to a sarcoma center. J. Surg. Oncol. © 2013 Wiley Periodicals, Inc.
    Journal of Surgical Oncology 09/2013; · 2.64 Impact Factor
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    ABSTRACT: This study aims to evaluate the change in comprehension of diagnoses, treatment plans, and discharge instructions after orthopaedic trauma patients are given an informational document that includes pictorial representations at the time of discharge. It also seeks to determine if the intervention has a greater impact on patients with lower educational backgrounds. Prospective comparative cohort study. Academic Level 1 trauma center. From April to December 2011, 529 orthopaedic trauma patients with an operatively fixed isolated fracture were eligible for inclusion. 299 eligible questionnaires were collected (56.5% response rate). Patients were administered a questionnaire regarding their treatment and discharge instructions during their first postoperative clinic visit prior to being seen by a physician. The questionnaire included demographic information and questions regarding: (1) which bone was fractured; (2) type of implanted fixation; (3) weight-bearing status; (4) expected recovery time; and (5) need for DVT prophylaxis. All patients had received verbal instructions outlining this information at postoperative hospital discharge. During the second half of the study, patients were given an additional informational sheet with both text and pictorial representations at discharge. Multivariable log-binomial regression analyses were used to examine the impact of this intervention. 146 patients were given only the standard discharge instructions, while 153 patients were also administered the additional information document. The mean score for patients who received the intervention was 2.90 (out of 5) compared to the mean score of 2.54 for patients who did not receive the intervention (p=0.013). Patients who received the intervention were 1.3 times more likely to know which bone was fractured (p=0.007) and 1.1 times more likely to be able to correctly name the medication(s) they were prescribed for DVT prophylaxis (p=0.03). Overall performance on comprehension questionnaires in orthopaedic trauma patients was significantly improved via a text and pictorial intervention. The intervention did not preferentially aid patients with lower education backgrounds. Future studies should evaluate long-term postoperative results to determine if improved patient comprehension has an effect on surgical outcomes and patient satisfaction.
    Journal of orthopaedic trauma 07/2013; · 1.78 Impact Factor
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    ABSTRACT: BACKGROUND: Although survival outcomes have been evaluated between those undergoing a planned primary excision and those undergoing a reexcision following an unplanned resection, the financial implications associated with a reexcision have yet to be elucidated. METHODS: A query for financial data (professional, technical, indirect charges) for soft tissue sarcoma excisions from 2005 to 2008 was performed. A total of 304 patients (200 primary excisions and 104 reexcisions) were identified. Wilcoxon rank sum tests and χ (2) or Fisher's exact tests were used to compare differences in demographics and tumor characteristics. Multivariable linear regression analyses were performed with bootstrapping techniques. RESULTS: The average professional charge for a primary excision was $9,694 and $12,896 for a reexcision (p < .001). After adjusting for tumor size, American Society of Anesthesiologists status, grade, and site, patients undergoing reexcision saw an increase of $3,699 in professional charges more than those with a primary excision (p < .001). Although every 1-cm increase in size of the tumor results in an increase of $148 for a primary excision (p = .006), size was not an independent factor in affecting reexcision charges. The grade of the tumor was positively associated with professional charges of both groups such that higher-grade tumors resulted in higher charges compared to lower-grade tumors (p < .05). CONCLUSIONS: Reexcision of an incompletely excised sarcoma results in significantly higher professional charges when compared to a single, planned complete excision. Additionally, when the cost of the primary unplanned surgery is considered, the financial burden nearly doubles.
    Annals of Surgical Oncology 04/2013; · 4.12 Impact Factor
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    ABSTRACT: BACKGROUND AND PURPOSE: Fear of movement is a risk factor for poor postoperative outcomes in patients following spine surgery. The purpose of this study was to describe the effects of a cognitive-behavioral based physical therapy (CBPT) intervention in patients with high fear of movement following lumbar spine surgery and assess the feasibility of physical therapists delivering cognitive-behavioral techniques over the phone. CASE DESCRIPTION: Eight patients who underwent surgery for a lumbar degenerative condition completed the 6 session CBPT intervention. The intervention included empirically-supported behavioral self-management, problem-solving, cognitive restructuring and relaxation strategies, and was conducted in person and then weekly over the phone. Patient-reported outcomes of pain and disability were assessed at baseline (6 weeks after surgery), post-intervention (3 months after surgery), and 6 months after surgery. Performance-based outcomes were tested at baseline and post-intervention. The outcome measures were the Brief Pain Inventory, Oswestry Disability Index, and 5 Chair Stand and 10-meter Walk tests. OUTCOMES: Seven of the patients demonstrated a clinically significant reduction in pain and all 8 of the patients had a clinically significant reduction in disability at 6 month follow-up. Improvement on the performance-based tests was also noted post-intervention, with 5 patients demonstrating clinically meaningful change on the 10-meter Walk test. DISCUSSION: Findings suggest that physical therapists can feasibly implement cognitive-behavioral skills over the phone and may positively affect outcomes after spine surgery. However, a randomized clinical trial is needed to confirm the results of this case series and the efficacy of the CBPT intervention. Clinical implications include broadening the availability of well-accepted cognitive-behavioral strategies by expanding implementation to physical therapists and through a telephone delivery model.
    Physical Therapy 04/2013; · 2.78 Impact Factor
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    ABSTRACT: Black race has been associated with a higher rate of complications following total joint arthroplasty, such as infection, deep vein thrombosis, pulmonary embolism, and death. We hypothesized that there would be no significant association between black race and adverse outcome when medical conditions were adjusted for. Data on 585,269 patients from the Nationwide Inpatient Samples were assessed by multivariable logistic regression analysis. Black race was significantly associated with postoperative complication and death. Comorbidities do not account for racial differences in adverse events. Black race was an independent predictive factor for increased complications and death following hip and knee arthroplasty.
    The Journal of arthroplasty 02/2013; · 1.79 Impact Factor
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    ABSTRACT: BACKGROUND: This study will evaluate whether or not texting frequency while driving and/or texting frequency in general are associated with an increased risk of incurring a motor vehicle collision (MVC) resulting in orthopaedic trauma injuries. METHODS: All patients who presented to the Vanderbilt University Medical Center Orthopaedic Trauma Clinic were administered a questionnaire to determine background information, mean phone use, texting frequency, texting frequency while driving, and whether or not the injury was the result of an MVC in which the patient was driving. RESULTS: 237 questionnaires were collected. 60 were excluded due to incomplete date, leaving 57 questionnaires in the MVC group and 120 from patients with non-MVC injuries. Patients who sent more than 30 texts per week ("heavy texters") were 2.22 times more likely to be involved in an MVC than those who texted less frequently. 84% of respondents claimed to never text while driving. Dividing the sample into subsets on the basis of age (25 years of age or below considered "young adult," and above 25 years of age considered "adult"),young, heavy texters were 6.76 times more likely to be involved in an MVC than adult non-heavy texters (p = 0.000). Similarly, young adult, non-heavy texters were 6.65 (p = 0.005) times more likely to be involved in an MVC, and adult, heavy texters were 1.72 (p = 0.186) times more likely to be involved in an MVC. CONCLUSIONS: Patients injured in an MVC sent more text messages per week than non-MVC patients. Additionally, controlling for age demonstrated that young age and heavy general texting frequency combined had the highest increase in MVC risk, with the former being the variable of greatest effect. © 2013 KUMS, All rights reserved.
    Journal of injury & violence research 02/2013;
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    ABSTRACT: BACKGROUND AND OBJECTIVES: Administration of preoperative radiotherapy for extremity soft tissue sarcoma improves local control, while allowing for a more conservative surgical resection. During radiation treatment tumor size typically decreases or remains constant. In a subset of patients, however, a size increase in the tumor occurs. Our goal was to investigate the prognosis of patients who had a size increase of at least 20% over the course of preoperative radiotherapy versus those who did not. METHODS: This retrospective study evaluated 70 patients treated for localized primary STS of the extremities between January 2000 and December 2008. Kaplan-Meier curves for disease-specific and metastasis-free survival were calculated for both groups. RESULTS: Sixty-one patients had stable or decrease local tumor size following preoperative radiotherapy and nine patients had an increase of at least 20% in tumor size. There were no statistically significant differences found in disease-specific survival and metastasis-free survival (Gray's test, P = 0.93 and P = 0.68, respectively) among the two groups. CONCLUSION: Our results indicate that a 20% increase in tumor size following preoperative radiotherapy did not result in a worse outcome for patients when compared to those who had stable or decrease local tumor size following preoperative radiotherapy. J. Surg. Oncol © 2013 Wiley Periodicals, Inc.
    Journal of Surgical Oncology 02/2013; · 2.64 Impact Factor
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    ABSTRACT: OBJECTIVES:: This study was designed to evaluate risk factors of infection following bicondylar tibial plateau fractures. We hypothesized that open fractures and smoking would be associated with deep infection requiring reoperation. DESIGN:: We retrospectively identified all bicondylar (AO/OTA 41-C) tibial plateau fractures treated operatively over an eight-year period from 2002 to 2010. SETTING:: Single, high-volume level-one trauma center. PATIENTS/PARTICIPANTS:: 302 patients ≥18 years of age were identified as undergoing operative fixation of bicondylar (AO/OTA 41-C) tibial plateau fractures during this time period. INTERVENTION:: Open reduction internal fixation of bicondylar (AO/OTA 41-C) tibial plateau fractures. MAIN OUTCOME MEASUREMENTS:: Bivariate and multivariable logistic regression analyses were used to assess the association between patient demographics and clinical characteristics and deep infection requiring reoperation. Variables that were significant at p < .05 in bivariate analyses were entered into a multivariable logistic regression model. RESULTS:: Forty-Three of 302 (14.2%) patients developed deep infection requiring reoperation. Methicillin-resistant S. aureus (MRSA) was cultured in 20 of 43 patients with deep infections (46.5%). An external fixator was initially placed prior to definitive fixation in 81.4% of patients and definitive surgical treatment was delayed an average of 17.5 days. Eighty-five patients required a reoperation following definitive fixation (28.1%). Open fracture (OR 3.44, p=0.003); smoking (OR 2.40, p=0.02); compartment syndrome requiring fasciotomies (OR 3.81, p=0.01); and fractures requiring two incisions and two plates (OR 3.19, p=0.01) were all risk factors for deep infection requiring reoperation. CONCLUSIONS:: In spite of a staged protocol with temporizing external fixation and delayed fixation, deep infection rate remained high. A disproportionate amount of MRSA (47%) was cultured from deep infections in this population and MRSA prophylaxis may be considered. Smoking was the only patient modifiable predictor of deep infection identified and patients should be informed of the increased risk of deep infection associated with their choice to continue smoking.
    Journal of orthopaedic trauma 01/2013; · 1.78 Impact Factor
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    ABSTRACT: Background. One-third of all extremity soft tissue sarcomas are misdiagnosed and inappropriately excised without proper preoperative diagnosis and planning. This study aimed at examining the clinical judgment of residents in both general and orthopaedic surgery and at determining whether resident education plays a role in appropriately managing unknown soft tissue masses. Methods. A case-based survey was used to assess clinical decisions, practice patterns, and demographics. Aggregate response for all of the clinical cases by each respondent was correlated with the selections made for practice patterns and demographic data. Results. A total of 381 responses were returned. A higher percentage of respondents from the orthopaedic group (84.2%) noted having a dedicated STS rotation as compared to the general surgery group (35.8%) P < 0.001. Depth, size, and location of the mass, rate of growth, and imaging characteristics were considered to be important factors. Each additional year of training resulted in 10% increased odds of selecting the correct clinical decision for both groups. Conclusion. Our study showed that current residents in both orthopaedic surgery and general surgery are able to appropriately identify patients with suspicious masses. Continuing education in sarcoma care should be implemented beyond the years of residency training.
    Sarcoma 01/2013; 2013:679323.

Publication Stats

140 Citations
97.87 Total Impact Points


  • 2009–2014
    • Vanderbilt University
      • • Department of Orthopaedic Surgery and Rehabilitation
      • • Department of Medicine
      Nashville, Michigan, United States
  • 2013
    • University of Alabama at Birmingham
      • Divison of Orthopaedic Surgery
      Birmingham, Alabama, United States
    • Barnes Jewish Hospital
      San Luis, Missouri, United States
  • 2012
    • Walter Reed National Military Medical Center
      Washington, Washington, D.C., United States
  • 2008
    • Johns Hopkins Medicine
      • Department of Orthopaedic Surgery
      Baltimore, Maryland, United States
  • 2006–2007
    • Johns Hopkins University
      • Department of Physical Medicine and Rehabilitation
      Baltimore, Maryland, United States